Provider Demographics
NPI:1982680542
Name:RADIOLOGY UNLIMITED, PA
Entity Type:Organization
Organization Name:RADIOLOGY UNLIMITED, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHOLAMREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-576-3680
Mailing Address - Street 1:PO BOX 3432
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3432
Mailing Address - Country:US
Mailing Address - Phone:361-576-3680
Mailing Address - Fax:361-576-4219
Practice Address - Street 1:815 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-3025
Practice Address - Country:US
Practice Address - Phone:361-576-3680
Practice Address - Fax:361-576-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK98412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0077HSOtherBCBS OF TX #
TX0077HSOtherBCBS OF TX #