Healthcare Provider Details

I. General information

NPI: 1962645408
Provider Name (Legal Business Name): COMANCHE COUNTY HOSPITAL AUTHORITY SOUTHWEST RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 DETROIT ST
DENVER CO
80206-4314
US

IV. Provider business mailing address

PO BOX 1017
GREENVILLE TX
75403-1017
US

V. Phone/Fax

Practice location:
  • Phone: 800-945-2455
  • Fax:
Mailing address:
  • Phone: 972-664-6956
  • Fax: 770-237-1831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOE K CUMMINS
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 580-510-7070