Provider Demographics
NPI:1972084432
Name:MOPAC IMAGING, LP
Entity type:Organization
Organization Name:MOPAC IMAGING, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-660-3001
Mailing Address - Street 1:3742 FAR WEST BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3044
Mailing Address - Country:US
Mailing Address - Phone:512-372-1062
Mailing Address - Fax:512-372-1064
Practice Address - Street 1:3742 FAR WEST BLVD STE 109
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3044
Practice Address - Country:US
Practice Address - Phone:512-372-1062
Practice Address - Fax:512-372-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology