Healthcare Provider Details

I. General information

NPI: 1528680378
Provider Name (Legal Business Name): SOUTH TEXAS RDI GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 FM 1463 RD STE 500-134
KATY TX
77494-7412
US

IV. Provider business mailing address

5006 WATERBECK ST
WESTON LAKES TX
77441-4143
US

V. Phone/Fax

Practice location:
  • Phone: 281-850-5325
  • Fax:
Mailing address:
  • Phone: 281-850-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: AVERY OBLEPIAS
Title or Position: ADMINISTRATOR
Credential: RRT
Phone: 281-850-5325