Provider Demographics
NPI:1265423693
Name:M&S RADIOLOGY ASSOCIATES, PA
Entity type:Organization
Organization Name:M&S RADIOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-892-0228
Mailing Address - Street 1:DEPT D8288
Mailing Address - Street 2:P O BOX 650002
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0282
Mailing Address - Country:US
Mailing Address - Phone:800-666-1816
Mailing Address - Fax:706-653-5917
Practice Address - Street 1:8715 VILLAGE DR STE 320
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5407
Practice Address - Country:US
Practice Address - Phone:210-858-8019
Practice Address - Fax:210-455-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164588901Medicaid
TX164588901Medicaid