Provider Demographics
NPI:1578574331
Name:CENTRAL SAN ANTONIO IMAGING
Entity Type:Organization
Organization Name:CENTRAL SAN ANTONIO IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WISNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-208-2147
Mailing Address - Street 1:7418 JOHN SMITH
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6020
Mailing Address - Country:US
Mailing Address - Phone:210-614-0959
Mailing Address - Fax:
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-208-2147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T32ZOtherBCBS
TXDN6641OtherMEDICARE RAILROAD
TX085205501Medicaid
TX085205501Medicaid