Provider Demographics
NPI:1932302049
Name:HOME CARE X-RAY SERVICE, INC.
Entity Type:Organization
Organization Name:HOME CARE X-RAY SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:254-666-6192
Mailing Address - Street 1:PO BOX 23243
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-3243
Mailing Address - Country:US
Mailing Address - Phone:254-666-6192
Mailing Address - Fax:254-666-6198
Practice Address - Street 1:207 BUCKINGHAM PL
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-4204
Practice Address - Country:US
Practice Address - Phone:254-666-6192
Practice Address - Fax:254-666-6198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR145662471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX630000131OtherPALMETTO GBA-RAILROAD MED
TX086075101Medicaid
TX459823Medicare ID - Type Unspecified