Healthcare Provider Details

I. General information

NPI: 1639423312
Provider Name (Legal Business Name): LONE STAR ADVANCED IMAGING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 CAMERON RD # 2-153
AUSTIN TX
78754-3831
US

IV. Provider business mailing address

7901 CAMERON RD # 2-153
AUSTIN TX
78754-3831
US

V. Phone/Fax

Practice location:
  • Phone: 512-973-9223
  • Fax:
Mailing address:
  • Phone: 512-973-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: ARTUR YENGOYAN
Title or Position: PRESIDENT
Credential:
Phone: 512-973-9223