Healthcare Provider Details

I. General information

NPI: 1487280210
Provider Name (Legal Business Name): COMMUNITY RADIOLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PKWY RADIOLOGY DEPARTMENT
AUSTIN TX
78738
US

IV. Provider business mailing address

PO BOX 208534
DALLAS TX
75320-8534
US

V. Phone/Fax

Practice location:
  • Phone: 512-820-8098
  • Fax:
Mailing address:
  • Phone: 888-372-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARLEE LEBLEU
Title or Position: VICE PRESIDENT
Credential:
Phone: 480-321-7026