Provider Demographics
NPI:1255842555
Name:IRON HORSE AMIGOS
Entity Type:Organization
Organization Name:IRON HORSE AMIGOS
Other - Org Name:ANGELO MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHENAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-234-8889
Mailing Address - Street 1:4114 S JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6377
Mailing Address - Country:US
Mailing Address - Phone:325-703-6741
Mailing Address - Fax:325-703-6742
Practice Address - Street 1:4114 S JACKSON STREET
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6377
Practice Address - Country:US
Practice Address - Phone:325-703-6741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1036DCOtherBCBS