Provider Demographics
NPI:1417912544
Name:RANEK, LC
Entity Type:Organization
Organization Name:RANEK, LC
Other - Org Name:THE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-462-9909
Mailing Address - Street 1:PO BOX 632067
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-2067
Mailing Address - Country:US
Mailing Address - Phone:936-462-9909
Mailing Address - Fax:936-462-8528
Practice Address - Street 1:4932 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1878
Practice Address - Country:US
Practice Address - Phone:936-462-9909
Practice Address - Fax:936-462-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0433DCOtherBLUECROSS BLUESHIELD
P00249391OtherRAILROAD MEICARE
TX1718710-01Medicaid
TXFTVXU3Medicare PIN