1518149624 NPI number — X-RAY ON WHEELS, INC.

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 1518149624 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:
1518149624
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2016
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:
11/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STROLENY
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASST. ADMIN.
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: R36534 , 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: 086070202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00814456 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 630000371 . This is a "RAILROAD MEDICARE GBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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