Provider Demographics
NPI:1265481279
Name:NATIONAL IMAGING AFFILIATES OF SAN ANGELO, LLC
Entity Type:Organization
Organization Name:NATIONAL IMAGING AFFILIATES OF SAN ANGELO, LLC
Other - Org Name:HEALTHSOUTH DIAGNOSTIC CENTER OF SAN ANGELO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIRESHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-685-5141
Mailing Address - Street 1:4241 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5687
Mailing Address - Country:US
Mailing Address - Phone:325-224-8288
Mailing Address - Fax:325-224-8293
Practice Address - Street 1:4241 SOUTHWEST BLVD
Practice Address - Street 2:SUITE 107B
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5687
Practice Address - Country:US
Practice Address - Phone:325-224-8288
Practice Address - Fax:325-224-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTX043Medicare ID - Type UnspecifiedIDTF