1417915984 NPI number — CENTRAL TEXAS ADVANCED MEDICAL IMAGING LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417915984 NPI number — CENTRAL TEXAS ADVANCED MEDICAL IMAGING LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL TEXAS ADVANCED MEDICAL IMAGING LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417915984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20548
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76702-0548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-755-7761
Provider Business Mailing Address Fax Number:
254-752-3717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 RICHLAND WEST CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-751-9490
Provider Business Practice Location Address Fax Number:
254-755-4413
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RISINGER
Authorized Official First Name:
DREW
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
254-753-2398

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 141584601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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