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General NPI Number Information
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NPI Number | 1306933098
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 800 5TH AVE SUITE 400
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City | FORT WORTH
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State | TX
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Zip | 76104-7305
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Country | US
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Telephone | 817-924-1999
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Fax | 817-886-0881
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Provider Business Mailing Address
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Address Line | 600 CONGRESS AVE SUITE 2150
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City | AUSTIN
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State | TX
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Zip | 78701-2991
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Country | US
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Telephone | 512-370-8100
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Fax | 512-370-8198
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. EILEEN KANEWSKE
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Credential |
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Telephone | 512-370-8114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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