MEDICARE: SAN BENITO IMAGING CENTER LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085U0001X	Diagnostic Ultrasound Physician
2	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487754438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN BENITO IMAGING CENTER LP

Provider Business Mailing Address
First Line	:	200 N SAM HOUSTON BLVD
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-4655
Country	:	US
Telephone Number	:	956-399-2666
Fax Number	:	956-399-2638

Provider Business Practice Location Address
First Line	:	200 N SAM HOUSTON BLVD
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-4655
Country	:	US
Telephone Number	:	956-399-2666
Fax Number	:	956-399-2638

Authorized Official
Title or Position	:	FACILITY DIRECTOR
Name	:	MR. RUDY RIVAS
Credential	:
Telephone Number	:	956-399-2666

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	04/10/2012

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