Healthcare Provider Details

I. General information

NPI: 1912931957
Provider Name (Legal Business Name): BEXAR IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7355 BARLITE BLVD STE 201
SAN ANTONIO TX
78224-1340
US

IV. Provider business mailing address

19500 IH-10W MS 1-5030 ATTN: LICENSING & REGULATORY
SAN ANTONIO TX
78257
US

V. Phone/Fax

Practice location:
  • Phone: 210-806-9255
  • Fax:
Mailing address:
  • Phone: 210-617-4706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ZIMMERMAN
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 210-617-4741