Provider Demographics
NPI:1255454252
Name:DEL RIO IMAGING CENTER PA
Entity type:Organization
Organization Name:DEL RIO IMAGING CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHARTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-703-8543
Mailing Address - Street 1:2209 BEDELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TN
Mailing Address - Zip Code:78840
Mailing Address - Country:US
Mailing Address - Phone:830-703-8543
Mailing Address - Fax:830-774-1430
Practice Address - Street 1:2209 BEDELL
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TN
Practice Address - Zip Code:78840
Practice Address - Country:US
Practice Address - Phone:830-703-8543
Practice Address - Fax:830-774-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR274272471B0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00500TMedicare ID - Type Unspecified