1447261219 NPI number — BRAZOS MOBILE IMAGING,INC.

Table of content: (NPI 1447261219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447261219 NPI number — BRAZOS MOBILE IMAGING,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAZOS MOBILE IMAGING,INC.
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:
1447261219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21265
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:
76702-1265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-772-8248
Provider Business Mailing Address Fax Number:
254-772-8457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 CHAMA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEWITT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76643-3368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-772-8248
Provider Business Practice Location Address Fax Number:
254-870-1991
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAHIMI
Authorized Official First Name:
ABBAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
254-772-8248

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335V00000X , with the licence number: R21052 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 459851 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 630000698 . This is a "PALMETTO GBA NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086096702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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