Provider Demographics
NPI:1700368222
Name:BEXAR IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:BEXAR IMAGING CENTER, LLC
Other - Org Name:BEXAR LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRUNDHOEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-617-4728
Mailing Address - Street 1:25 NE LOOP 410 STE 121A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5898
Mailing Address - Country:US
Mailing Address - Phone:210-384-8439
Mailing Address - Fax:
Practice Address - Street 1:25 NE LOOP 410 STE 121A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5898
Practice Address - Country:US
Practice Address - Phone:210-384-8439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory