Healthcare Provider Details

I. General information

NPI: 1578574331
Provider Name (Legal Business Name): CENTRAL SAN ANTONIO IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 MCCULLOUGH AVE SUITE 160
SAN ANTONIO TX
78212-5609
US

IV. Provider business mailing address

7418 JOHN SMITH SUITE 218
SAN ANTONIO TX
78229-6020
US

V. Phone/Fax

Practice location:
  • Phone: 210-208-2147
  • Fax:
Mailing address:
  • Phone: 210-614-0959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN K. WISNIEWSKI
Title or Position: CFO
Credential:
Phone: 210-208-2147