Provider Demographics
NPI:1326082603
Name:DIAGNOSTIC OUTPATIENT IMAGING PARTNERSHIP LTD
Entity Type:Organization
Organization Name:DIAGNOSTIC OUTPATIENT IMAGING PARTNERSHIP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOUSHKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-881-1900
Mailing Address - Street 1:6065 MONTANA AVE
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1835
Mailing Address - Country:US
Mailing Address - Phone:915-881-1900
Mailing Address - Fax:915-771-9345
Practice Address - Street 1:6065 MONTANA AVE
Practice Address - Street 2:BLDG A STE 6
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1835
Practice Address - Country:US
Practice Address - Phone:915-881-1900
Practice Address - Fax:915-771-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109395701Medicaid
TXCG1478Medicare PIN