Provider Demographics
NPI:1982600599
Name:ABILENE IMAGING CENTER LLC
Entity type:Organization
Organization Name:ABILENE IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-437-0560
Mailing Address - Street 1:750 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3018
Mailing Address - Country:US
Mailing Address - Phone:325-437-0560
Mailing Address - Fax:325-437-0555
Practice Address - Street 1:750 N 18TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3018
Practice Address - Country:US
Practice Address - Phone:325-437-0560
Practice Address - Fax:325-437-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160862201Medicaid
TXFTA070Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER