Provider Demographics
NPI:1407264369
Name:WATERLOO IMAGING LLC
Entity Type:Organization
Organization Name:WATERLOO IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-448-3278
Mailing Address - Street 1:4316 JAMES CASEY ST # F-110A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1116
Mailing Address - Country:US
Mailing Address - Phone:512-448-3278
Mailing Address - Fax:
Practice Address - Street 1:4316 JAMES CASEY ST # F-110A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1116
Practice Address - Country:US
Practice Address - Phone:512-448-3278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology