Provider Demographics
NPI:1891920047
Name:RIVER CITY RADIOLOGY, LLC
Entity Type:Organization
Organization Name:RIVER CITY RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-454-9598
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-454-9598
Mailing Address - Fax:512-458-6770
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:SUITE D-1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-454-9598
Practice Address - Fax:512-458-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology