Provider Demographics
NPI:1427016161
Name:TEXAS RADIOLOGY ASSOCIATES LLP
Entity Type:Organization
Organization Name:TEXAS RADIOLOGY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-867-7862
Mailing Address - Street 1:1820 PRESTON PARK BLVD STE 2400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3716
Mailing Address - Country:US
Mailing Address - Phone:972-867-7862
Mailing Address - Fax:972-612-1623
Practice Address - Street 1:1820 PRESTON PARK BLVD STE 2400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3716
Practice Address - Country:US
Practice Address - Phone:972-867-7862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081568001Medicaid
TX00A65JMedicare PIN