Healthcare Provider Details

I. General information

NPI: 1538400700
Provider Name (Legal Business Name): MOUNTAIN VIEW RADIOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 GATEWAY BLVD W SUITE 140
EL PASO TX
79925-7934
US

IV. Provider business mailing address

10501 GATEWAY BLVD W SUITE 140
EL PASO TX
79925-7934
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-7300
  • Fax: 915-833-3500
Mailing address:
  • Phone: 915-544-7300
  • Fax: 915-833-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG1927
License Number StateTX

VIII. Authorized Official

Name: DR. THOMAS D SPERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 915-544-7300