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General NPI Number Information
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NPI Number | 1447261219
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Entity Type | Organization
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Legal Business Name | BRAZOS MOBILE IMAGING,INC.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 208 CHAMA DR
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City | HEWITT
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State | TX
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Zip | 76643-3368
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Country | US
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Telephone | 254-772-8248
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Fax | 254-870-1991
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Provider Business Mailing Address
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Address Line | PO BOX 21265
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City | WACO
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State | TX
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Zip | 76702-1265
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Country | US
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Telephone | 254-772-8248
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Fax | 254-772-8457
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Authorized Official
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Title or Position | PRESIDENT
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Name | ABBAS RAHIMI
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Credential | BSRT, RTR
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Telephone | 254-772-8248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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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 | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | R21052
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License Number State | TX
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