=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457376618
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RD IMAGING SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 EAGLE CREEK RANCH DRIVE
-----------------------------------------------------
City | FLORESVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78114-9238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-393-9692
-----------------------------------------------------
Fax | 830-393-8632
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213 EAGLE CREEK RANCH DRIVE
-----------------------------------------------------
City | FLORESVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78114-9238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-393-9692
-----------------------------------------------------
Fax | 830-393-8632
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMES DANIEL WILSON
-----------------------------------------------------
Credential | RT(R)
-----------------------------------------------------
Telephone | 830-393-9692
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2471B0102X
-----------------------------------------------------
Taxonomy Name | Bone Densitometry Radiologic Technologist
-----------------------------------------------------
License Number | 25248
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------