Provider Demographics
NPI:1043320377
Name:SOUTH TEXAS IMAGING CENTER K PA
Entity Type:Organization
Organization Name:SOUTH TEXAS IMAGING CENTER K PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPILIVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-432-1100
Mailing Address - Street 1:10700 RICHMOND AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-3045
Practice Address - Country:US
Practice Address - Phone:713-432-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084BFMedicare ID - Type Unspecified