Provider Demographics
NPI:1104852664
Name:DIAGNOSTIC IMAGING ASSOCIATES PA
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SILVESTRE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-576-2116
Mailing Address - Street 1:1607 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5213
Mailing Address - Country:US
Mailing Address - Phone:361-576-2116
Mailing Address - Fax:361-576-5020
Practice Address - Street 1:506 E SAN ANTONIO STREET
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-575-7441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00695RMedicare ID - Type Unspecified