Basic Information
| Provider Information | |||||||||
| NPI: | 1245817386 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIG SPRING RADIOLOGY ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 NORTH LOOP W STE 240 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770081677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134269102 | ||||||||
| FaxNumber: | 7134264015 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 W 11TH PL | ||||||||
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| City: | BIG SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797204114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4322631211 | ||||||||
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| ProviderEnumerationDate: | 03/25/2021 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | CASTILLO | ||||||||
| AuthorizedOfficialFirstName: | MARIO | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7134269102 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D., PH.D. | ||||||||
| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.