=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124447628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWMV IMAGING PARTNERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2014
-----------------------------------------------------
Last Update Date | 08/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5625 EIGER RD SUITE 165
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78735-8977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-519-3474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12554 RIATA VISTA CIR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78727-6431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GREGORY KARNAZE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 512-795-5100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | R38463
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------