Basic Information
| Provider Information | |||||||||
| NPI: | 1023439767 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH IMAGING PARTNERS, LLC | ||||||||
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| OtherOrganizationName: | DBA ENVISION IMAGING AT SOUTH LAKE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8610 EXPLORER DRIVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809201036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7199554140 | ||||||||
| FaxNumber: | 7199554148 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 E. SOUTHLAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174245872 | ||||||||
| FaxNumber: | 8174243022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2013 | ||||||||
| LastUpdateDate: | 01/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | BENSON | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF REVENUE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7199554332 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 293D00000X | N | Laboratories | Physiological Laboratory | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.