Provider Demographics
NPI:1679871081
Name:RIVER CITY IMAGING ASSOCIATES PA
Entity Type:Organization
Organization Name:RIVER CITY IMAGING ASSOCIATES PA
Other - Org Name:RIVER CITY IMAGING CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PING-SUN
Authorized Official - Middle Name:KEVEN
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-704-2371
Mailing Address - Street 1:PO BOX 10270
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-0270
Mailing Address - Country:US
Mailing Address - Phone:903-663-4800
Mailing Address - Fax:903-663-9960
Practice Address - Street 1:333 N SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-2371
Practice Address - Fax:903-663-9960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVER CITY IMAGING ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-09
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF40602085R0202X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280346201Medicaid