Provider Demographics
NPI:1578545000
Name:CALERA, INC.
Entity Type:Organization
Organization Name:CALERA, INC.
Other - Org Name:RIO GRANDE VALLEY MOBILE X-RAYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALERA
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:956-783-9779
Mailing Address - Street 1:1421 SIOUX RD.
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516
Mailing Address - Country:US
Mailing Address - Phone:956-783-9779
Mailing Address - Fax:956-783-7437
Practice Address - Street 1:1421 SIOUX RD.
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516
Practice Address - Country:US
Practice Address - Phone:956-783-9779
Practice Address - Fax:956-783-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR21636335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0861015-04Medicaid
TX086101503Medicaid
TX630001196OtherPALMETTO RR
TX086101501Medicaid
TX086101503Medicaid