Basic Information
| Provider Information | |||||||||
| NPI: | 1609115138 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CTOA-CENTRAL TEXAS WOMEN'S IMAGING CENTER, PLLC | ||||||||
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| OtherOrganizationName: | CENTRAL TEXAS WOMEN'S IMAGING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7718 WOOD HOLLOW DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787311648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122796701 | ||||||||
| FaxNumber: | 5122796750 | ||||||||
| Practice Location | |||||||||
| Address1: | 2220 PARK BEND DR | ||||||||
| Address2: | BUILDING 2, SUITE 301 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128737237 | ||||||||
| FaxNumber: | 5128377237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2013 | ||||||||
| LastUpdateDate: | 02/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | BUNING | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CENTRAL BUSINESS OFFICE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5122796707 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CENTRAL TEXAS OB/GYN ASSOCIATES, PLLC | ||||||||
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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 |
No ID Information.