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General NPI Number Information
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NPI Number | 1134863152
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Entity Type | Organization
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Legal Business Name | INDEPENDENT DIAGNOSTIC TESTING SOLUTIONS LLC
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 13710 PEBBLE POINT DR
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City | SAN ANTONIO
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State | TX
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Zip | 78231-1929
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Country | US
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Telephone | 210-254-2982
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Fax |
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Provider Business Mailing Address
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Address Line | 13710 PEBBLE POINT DR
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City | SAN ANTONIO
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State | TX
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Zip | 78231-1929
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | ALEX EPSTEIN
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Credential |
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Telephone | 210-254-2982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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