Provider Demographics
NPI:1881639615
Name:ACD-SA, LTD.
Entity Type:Organization
Organization Name:ACD-SA, LTD.
Other - Org Name:SENDERO IMAGING & TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-454-9598
Mailing Address - Street 1:PO BOX 301749
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-0030
Mailing Address - Country:US
Mailing Address - Phone:512-454-9597
Mailing Address - Fax:512-458-6770
Practice Address - Street 1:7220 LOUIS PASTEUR DR
Practice Address - Street 2:115
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4537
Practice Address - Country:US
Practice Address - Phone:210-614-8899
Practice Address - Fax:512-458-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000393261QP3300X
TX261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX470000396OtherRAILROAD MEDICARE
TX109373404Medicaid
TX109373402Medicaid
TX490004721OtherRAILROAD MEDICARE
TX109373404Medicaid
TX470000396OtherRAILROAD MEDICARE