Provider Demographics
NPI:1437125804
Name:DIAGNOSTIC SWALLOWING SERVICES LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC SWALLOWING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-439-6419
Mailing Address - Street 1:34 COUNTY ROAD 1102
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-6620
Mailing Address - Country:US
Mailing Address - Phone:903-439-6419
Mailing Address - Fax:
Practice Address - Street 1:34 COUNTY ROAD 1102
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-6620
Practice Address - Country:US
Practice Address - Phone:903-439-6419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00117DCOtherBLUE CROSS/BLUE SHIELD
TX00735RMedicare ID - Type UnspecifiedLOCALITY 20 TX