Provider Demographics
NPI:1932231578
Name:WESLACO DIAGNOSTIC IMAGING CENTER, LP
Entity Type:Organization
Organization Name:WESLACO DIAGNOSTIC IMAGING CENTER, LP
Other - Org Name:WESLACO DIAGNOSTIC IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R)
Authorized Official - Phone:956-447-4674
Mailing Address - Street 1:913 S AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6651
Mailing Address - Country:US
Mailing Address - Phone:956-447-4674
Mailing Address - Fax:956-447-4670
Practice Address - Street 1:913 S AIRPORT DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6651
Practice Address - Country:US
Practice Address - Phone:956-447-4674
Practice Address - Fax:956-447-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR28811261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTUXV8Medicare ID - Type UnspecifiedMEDICARE NUMBER