Provider Demographics
NPI:1912015587
Name:SAN ANTONIO DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:SAN ANTONIO DIAGNOSTIC IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-772-7749
Mailing Address - Street 1:PO BOX 2569
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77497-2569
Mailing Address - Country:US
Mailing Address - Phone:800-249-3478
Mailing Address - Fax:713-592-6772
Practice Address - Street 1:10007 HUEBNER RD
Practice Address - Street 2:BUILDING 2, SUITE 204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1640
Practice Address - Country:US
Practice Address - Phone:210-696-0360
Practice Address - Fax:210-696-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112643502Medicaid
TX00R93RMedicare PIN