Provider Demographics
NPI:1992746887
Name:THE IMAGING CENTER AT STONE OAK
Entity type:Organization
Organization Name:THE IMAGING CENTER AT STONE OAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-495-5100
Mailing Address - Street 1:PO BOX 1334
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78295-1334
Mailing Address - Country:US
Mailing Address - Phone:210-495-5100
Mailing Address - Fax:
Practice Address - Street 1:19223 STONEHUE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3456
Practice Address - Country:US
Practice Address - Phone:210-495-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR293672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00260ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER