1245322627 NPI number — X-RAY ON WHEELS, INC.

Table of content: (NPI 1245322627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245322627 NPI number — X-RAY ON WHEELS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
X-RAY ON WHEELS, 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:
1245322627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60577
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78466-0577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-881-9142
Provider Business Mailing Address Fax Number:
361-881-9202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4929 BURNEY DR
Provider Second Line Business Practice Location Address:
STE #100
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-881-9142
Provider Business Practice Location Address Fax Number:
361-881-9202
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUNBAR
Authorized Official First Name:
BRIDGET
Authorized Official Middle Name:
Authorized Official Title or Position:
COO/OWNER
Authorized Official Telephone Number:
361-881-9142

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X , with the licence number:  96713 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335V00000X , with the licence number: R12988 , 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: 630000371 . This is a "RAILROAD MEDICARE GBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086070202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 459818 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00814456 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086070201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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