Provider Demographics
NPI:1245322627
Name:X-RAY ON WHEELS, INC.
Entity type:Organization
Organization Name:X-RAY ON WHEELS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-881-9142
Mailing Address - Street 1:PO BOX 60577
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-0577
Mailing Address - Country:US
Mailing Address - Phone:361-881-9142
Mailing Address - Fax:361-881-9202
Practice Address - Street 1:4929 BURNEY DR
Practice Address - Street 2:STE #100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2708
Practice Address - Country:US
Practice Address - Phone:361-881-9142
Practice Address - Fax:361-881-9202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:X-RAY ON WHEELS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96713293D00000X
TXR12988335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX630000371OtherRAILROAD MEDICARE GBA
TX086070202Medicaid
TX459818OtherBCBS
TXP00814456OtherMEDICARE RAILROAD
TX086070201Medicaid
TX459818Medicare PIN
TX630000371OtherRAILROAD MEDICARE GBA