Provider Demographics
NPI:1720212822
Name:WESTERN IMAGING SERVICES, P.S.C
Entity Type:Organization
Organization Name:WESTERN IMAGING SERVICES, P.S.C
Other - Org Name:WESTERN IMAGING SERVICES, P.S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-834-2145
Mailing Address - Street 1:105 MENDEZ VIGO E
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4956
Mailing Address - Country:US
Mailing Address - Phone:787-834-2145
Mailing Address - Fax:787-265-4477
Practice Address - Street 1:105 ESTE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-2145
Practice Address - Fax:787-265-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4770261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography