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General NPI Number Information
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NPI Number | 1902089055
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL RADIATION SERVICES, PLLC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 1700 E SAUNDERS ST
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City | LAREDO
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State | TX
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Zip | 78041-5474
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Country | US
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Telephone | 956-796-3159
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Fax | 956-796-3173
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Provider Business Mailing Address
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Address Line | PO BOX 202340
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City | DALLAS
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State | TX
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Zip | 75320-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALLING/ACCOUNTING
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Name | S. DIANE SELLARS
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Credential |
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Telephone | 615-746-4711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | L5631
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License Number State | TX
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