Provider Demographics
NPI:1093848699
Name:ROUND ROCK IMAGING LLC
Entity type:Organization
Organization Name:ROUND ROCK IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-206-6198
Mailing Address - Street 1:8300 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5406
Mailing Address - Country:US
Mailing Address - Phone:800-730-0050
Mailing Address - Fax:
Practice Address - Street 1:16000 PARK VALLEY DR
Practice Address - Street 2:SUITE 150
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4008
Practice Address - Country:US
Practice Address - Phone:512-828-3220
Practice Address - Fax:512-828-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTX109Medicare ID - Type Unspecified