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General NPI Number Information
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NPI Number | 1700368222
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Entity Type | Organization
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Legal Business Name | BEXAR IMAGING CENTER, LLC
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 25 NE LOOP 410 STE 121A
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City | SAN ANTONIO
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State | TX
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Zip | 78216-5898
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Country | US
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Telephone | 210-384-8439
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Fax |
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Provider Business Mailing Address
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Address Line | 25 NE LOOP 410 STE 121A
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City | SAN ANTONIO
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State | TX
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Zip | 78216-5898
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Country | US
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Telephone | 210-384-8439
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BRYAN D GRUNDHOEFER
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Credential |
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Telephone | 210-617-4728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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