1891325288 NPI number — RADIX DIAGNOSTICS LLC

Table of content: (NPI 1891325288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891325288 NPI number — RADIX DIAGNOSTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIX DIAGNOSTICS 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:
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:
1891325288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38400 INTERSTATE 10 W APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOERNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78006-9001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-790-9631
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17301 N PERIMETER DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85255-5468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-857-8378
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZWIERS
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL CARE COORDINATOR
Authorized Official Telephone Number:
830-302-2753

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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