Provider Demographics
NPI:1851548754
Name:TEXAS MOBILE DIAGNOSTICS
Entity Type:Organization
Organization Name:TEXAS MOBILE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:210-602-4999
Mailing Address - Street 1:518 E RAMSEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4660
Mailing Address - Country:US
Mailing Address - Phone:210-545-7900
Mailing Address - Fax:
Practice Address - Street 1:518 E RAMSEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4660
Practice Address - Country:US
Practice Address - Phone:210-545-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty