1528226248 NPI number — RADIOLOGY CLINICS OF LAREDO

Table of content: (NPI 1528226248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528226248 NPI number — RADIOLOGY CLINICS OF LAREDO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY CLINICS OF LAREDO
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:
1528226248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 SPRINGFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78041-3296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-718-0092
Provider Business Mailing Address Fax Number:
956-726-9735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 SPRINGFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAREDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78041-3296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-718-0092
Provider Business Practice Location Address Fax Number:
956-726-9735
Provider Enumeration Date:
05/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RAFATI
Authorized Official First Name:
SALAH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-718-0092

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  R20169 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0206X , with the licence number: M00131 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: R20169 . This is a "XRAY CERT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A00131000 . This is a "TX DEPT STATE HEALTH ACCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 180893 . This is a "MAMMOGRAPHY CERT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 60024073 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: E4146 . This is a "TX LIC." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: M00131 . This is a "TX DEPT HEALTH RADIATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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