Provider Demographics
NPI:1295065605
Name:JOE D BRADSHAW
Entity type:Organization
Organization Name:JOE D BRADSHAW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:RT, RVT, RDMS
Authorized Official - Phone:806-729-1901
Mailing Address - Street 1:300 NE ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-8736
Mailing Address - Country:US
Mailing Address - Phone:806-729-1901
Mailing Address - Fax:806-293-4231
Practice Address - Street 1:2404 YONKERS ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-1820
Practice Address - Country:US
Practice Address - Phone:806-293-4231
Practice Address - Fax:806-293-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier