Provider Demographics
NPI:1912931957
Name:BEXAR IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:BEXAR IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNDHOEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-617-4728
Mailing Address - Street 1:25 NE LOOP 410
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5898
Mailing Address - Country:US
Mailing Address - Phone:210-384-8439
Mailing Address - Fax:210-348-1913
Practice Address - Street 1:25 NE LOOP 410
Practice Address - Street 2:SUITE 121
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5898
Practice Address - Country:US
Practice Address - Phone:210-384-8439
Practice Address - Fax:210-348-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTA067Medicare ID - Type Unspecified