Provider Demographics
NPI:1801193933
Name:EAST SAN ANTONIO IMAGES INC
Entity Type:Organization
Organization Name:EAST SAN ANTONIO IMAGES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-279-4501
Mailing Address - Street 1:7201 RR 2222
Mailing Address - Street 2:SUITE 2312
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-3208
Mailing Address - Country:US
Mailing Address - Phone:512-279-4501
Mailing Address - Fax:
Practice Address - Street 1:6300 BRIDGE POINT PKWY
Practice Address - Street 2:BLDG 3
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-5073
Practice Address - Country:US
Practice Address - Phone:512-279-4501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH68362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0046WKOtherBCBS