Provider Demographics
NPI:1528226248
Name:RADIOLOGY CLINICS OF LAREDO
Entity Type:Organization
Organization Name:RADIOLOGY CLINICS OF LAREDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAFATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-718-0092
Mailing Address - Street 1:5401 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3296
Mailing Address - Country:US
Mailing Address - Phone:956-718-0092
Mailing Address - Fax:956-726-9735
Practice Address - Street 1:5401 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3296
Practice Address - Country:US
Practice Address - Phone:956-718-0092
Practice Address - Fax:956-726-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR20169261QR0200X
TXM00131261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR20169OtherXRAY CERT
TXA00131000OtherTX DEPT STATE HEALTH ACCR
TX180893OtherMAMMOGRAPHY CERT
TX60024073OtherDPS
TXE4146OtherTX LIC.
TXM00131OtherTX DEPT HEALTH RADIATION