Provider Demographics
NPI:1306933098
Name:COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC
Entity type:Organization
Organization Name:COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEWSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-370-8114
Mailing Address - Street 1:600 CONGRESS AVE
Mailing Address - Street 2:SUITE 2150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2991
Mailing Address - Country:US
Mailing Address - Phone:512-370-8100
Mailing Address - Fax:512-370-8198
Practice Address - Street 1:800 5TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7305
Practice Address - Country:US
Practice Address - Phone:817-924-1999
Practice Address - Fax:817-886-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCJ2670Medicare PIN
TXFTXU41Medicare PIN