Provider Demographics
NPI:1083990717
Name:TEXAS RADIOLOGY ASSOCIATES LLP
Entity type:Organization
Organization Name:TEXAS RADIOLOGY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-867-7862
Mailing Address - Street 1:PO BOX 2285
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2285
Mailing Address - Country:US
Mailing Address - Phone:866-437-9810
Mailing Address - Fax:469-757-1095
Practice Address - Street 1:460 ENA RD
Practice Address - Street 2:200
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1779
Practice Address - Country:US
Practice Address - Phone:972-867-7862
Practice Address - Fax:972-612-1623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC0892OtherRR MEDICARE
TX081568002Medicaid
TX009767OtherBCBS
TX218812001Medicaid
TX081568001Medicaid
TX081568001Medicaid
TX00360RMedicare PIN
TX009767OtherBCBS