Basic Information
| Provider Information | |||||||||
| NPI: | 1033442082 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADMEDX IMAGING & WOMEN'S CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 PARK BEND DR BLDG 2 | ||||||||
| Address2: | STE 301 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128737237 | ||||||||
| FaxNumber: | 5128377237 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 PARK BEND DR BLDG 2 | ||||||||
| Address2: | STE 301 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128737237 | ||||||||
| FaxNumber: | 5128377237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2009 | ||||||||
| LastUpdateDate: | 09/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | MOJICA | ||||||||
| AuthorizedOfficialFirstName: | GIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5128737237 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085U0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | 238674 | 01 | TX | MQSA | OTHER |