Healthcare Provider Details

I. General information

NPI: 1033030424
Provider Name (Legal Business Name): BLUE AGAVE RADIOLOGY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 WHITT PARK PATH
LEANDER TX
78641-3975
US

IV. Provider business mailing address

3321 WHITT PARK PATH
LEANDER TX
78641-3975
US

V. Phone/Fax

Practice location:
  • Phone: 830-491-4040
  • Fax: 830-584-0995
Mailing address:
  • Phone: 830-491-4040
  • Fax: 830-584-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KNEPPER
Title or Position: OWNER
Credential:
Phone: 830-491-4040