1861449894 NPI number — BAAXTEN, LLC

Table of content: (NPI 1861449894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861449894 NPI number — BAAXTEN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAAXTEN, LLC
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:
BAAXTEN IMAGING CENTER
Provider Other Organization Name Type Code:
3
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:
1861449894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 S BRYAN RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78572-6626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-583-0004
Provider Business Mailing Address Fax Number:
956-583-5790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2302 S 77 SUNSHINESTRIP STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-412-2121
Provider Business Practice Location Address Fax Number:
956-412-2125
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEVINE
Authorized Official First Name:
MAGDALENA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
956-412-2121

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  R30029 , 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: 180651503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180651502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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