Provider Demographics
NPI:1740305622
Name:RADIOLOGY CONSULTANTS OF EL PASO
Entity type:Organization
Organization Name:RADIOLOGY CONSULTANTS OF EL PASO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:REISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-833-6631
Mailing Address - Street 1:200 S ALTO MESA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4426
Mailing Address - Country:US
Mailing Address - Phone:915-833-6631
Mailing Address - Fax:915-833-6618
Practice Address - Street 1:200 S ALTO MESA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4426
Practice Address - Country:US
Practice Address - Phone:915-833-6631
Practice Address - Fax:915-833-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AJ10Medicare ID - Type Unspecified