Provider Demographics
NPI:1225081748
Name:WESLACO ADVANCED MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:WESLACO ADVANCED MEDICAL IMAGING LLC
Other - Org Name:ADVANCED RADIOLOGY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAFATH
Authorized Official - Middle Name:
Authorized Official - Last Name:QURAISHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-973-9696
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-973-9696
Mailing Address - Fax:956-973-9616
Practice Address - Street 1:1125 S JAMES ST STE A
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-973-9696
Practice Address - Fax:956-973-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM1300X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX226054OtherMAMMAGRAPHY FDA
TX154223502Medicaid
TX154223502Medicaid