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General NPI Number Information
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NPI Number | 1790896868
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Entity Type | Organization
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Legal Business Name | TEXOMA MEDICAL CENTER JOINT VENTURE
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 1518 10TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4405
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Country | US
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Telephone | 940-322-2244
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Fax | 940-322-5511
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Provider Business Mailing Address
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Address Line | 1518 10TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4405
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Country | US
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Telephone | 940-322-2244
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Fax | 940-322-5511
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALIAKBAR MOSHTAGHI
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Credential | M.D.
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Telephone | 940-322-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | R27777
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License Number State | TX
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