Healthcare Provider Details

I. General information

NPI: 1932646015
Provider Name (Legal Business Name): WEST TEXAS FAMILY MEDICINE RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 QUINCY ST
PLAINVIEW TX
79072-4206
US

IV. Provider business mailing address

1806 QUINCY ST
PLAINVIEW TX
79072-4206
US

V. Phone/Fax

Practice location:
  • Phone: 806-288-7891
  • Fax: 806-288-7920
Mailing address:
  • Phone: 806-288-7891
  • Fax: 806-288-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA GRACIELA ORTEGA
Title or Position: BILLING MANAGER
Credential:
Phone: 806-213-9560