Healthcare Provider Details

I. General information

NPI: 1598791634
Provider Name (Legal Business Name): SOUTHWEST DIAGNOSTIC CENTERS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 SOUTH MOPAC
AUSTIN TX
78749-1113
US

IV. Provider business mailing address

6000 SOUTH MOPAC
AUSTIN TX
78749-1113
US

V. Phone/Fax

Practice location:
  • Phone: 512-891-9191
  • Fax: 512-891-1909
Mailing address:
  • Phone: 512-891-9191
  • Fax: 512-891-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: PAULA ROACH
Title or Position: CENTER DIRECTOR
Credential:
Phone: 512-891-9191