Provider Demographics
NPI:1417915984
Name:CENTRAL TEXAS ADVANCED MEDICAL IMAGING LP
Entity type:Organization
Organization Name:CENTRAL TEXAS ADVANCED MEDICAL IMAGING LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-753-2398
Mailing Address - Street 1:PO BOX 20548
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-0548
Mailing Address - Country:US
Mailing Address - Phone:254-755-7761
Mailing Address - Fax:254-752-3717
Practice Address - Street 1:312 RICHLAND WEST CIRCLE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-751-9490
Practice Address - Fax:254-755-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141584601Medicaid
TX141584601Medicaid
TX00260RMedicare PIN