Basic Information
| Provider Information | |||||||||
| NPI: | 1336188911 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGICAL CONSULTANTS ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1750 N HAMPTON RD | ||||||||
| Address2: | |||||||||
| City: | DESOTO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751152306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144205400 | ||||||||
| FaxNumber: | 2144205401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1750 N HAMPTON RD | ||||||||
| Address2: | |||||||||
| City: | DESOTO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751152306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149464397 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 09/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | VAN METER | ||||||||
| AuthorizedOfficialFirstName: | TRAVIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 2144205460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 | 112582501 | 05 | TX | MEDICAID |