Provider Demographics
NPI:1851368039
Name:SOUTH TEXAS RADIOLOGY GROUP PA
Entity Type:Organization
Organization Name:SOUTH TEXAS RADIOLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-616-7700
Mailing Address - Street 1:COLONNADE I, 9901 IH-10 WEST
Mailing Address - Street 2:SUITE 905
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COLONNADE I, 9901 IH-10 WEST
Practice Address - Street 2:SUITE 905
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230
Practice Address - Country:US
Practice Address - Phone:210-616-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121681401Medicaid
TX121681402OtherCSHCN
TXCN6751Medicare PIN
TX121681401Medicaid