=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528226248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADIOLOGY CLINICS OF LAREDO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2008
-----------------------------------------------------
Last Update Date | 09/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5401 SPRINGFIELD AVE
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-3296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-718-0092
-----------------------------------------------------
Fax | 956-726-9735
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5401 SPRINGFIELD AVE
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-3296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-718-0092
-----------------------------------------------------
Fax | 956-726-9735
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SALAH A RAFATI
-----------------------------------------------------
Credential | MD.
-----------------------------------------------------
Telephone | 956-718-0092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0206X
-----------------------------------------------------
Taxonomy Name | Mammography Clinic/Center
-----------------------------------------------------
License Number | M00131
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | R20169
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------