Provider Demographics
NPI:1629212840
Name:BEAUMONT RADIOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:BEAUMONT RADIOLOGY SERVICES LLC
Other - Org Name:HIGHLAND SPRINGS IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FONTOURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-558-4000
Mailing Address - Street 1:10 VIENNA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6832
Mailing Address - Country:US
Mailing Address - Phone:949-395-4536
Mailing Address - Fax:949-364-2632
Practice Address - Street 1:81 S. HIGHLAND SPRINGS AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:949-395-4536
Practice Address - Fax:949-364-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology