Provider Demographics
NPI:1598791634
Name:SOUTHWEST DIAGNOSTIC CENTERS LTD
Entity Type:Organization
Organization Name:SOUTHWEST DIAGNOSTIC CENTERS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-891-9191
Mailing Address - Street 1:6000 SOUTH MOPAC
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1113
Mailing Address - Country:US
Mailing Address - Phone:512-891-9191
Mailing Address - Fax:512-891-1909
Practice Address - Street 1:6000 SOUTH MOPAC
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1113
Practice Address - Country:US
Practice Address - Phone:512-891-9191
Practice Address - Fax:512-891-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2085R0202X, 208VP0000X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Not Answered293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003DCOtherBCBS
TXP00085382OtherMCARE RR
TXP00085382OtherMCARE RR