Basic Information
| Provider Information | |||||||||
| NPI: | 1164478186 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROSE IMAGING SPECIALISTS PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOLIS MAMMOGRAPHY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 203268 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753203053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666135807 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17080 RED OAK DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770902602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818806991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | CASSIN | ||||||||
| AuthorizedOfficialFirstName: | NAOMI | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE VP PROVIDER ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 2818858314 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | CK7444 | 01 | TX | RAILROAD MEDICARE | OTHER |