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General NPI Number Information
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NPI Number | 1932302049
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Entity Type | Organization
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Legal Business Name | HOME CARE X-RAY SERVICE, INC.
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 207 BUCKINGHAM PL
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City | HEWITT
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State | TX
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Zip | 76643-4204
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Country | US
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Telephone | 254-666-6192
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Fax | 254-666-6198
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Provider Business Mailing Address
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Address Line | PO BOX 23243
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City | WACO
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State | TX
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Zip | 76702-3243
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Country | US
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Telephone | 254-666-6192
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Fax | 254-666-6198
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL A GREEN
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Credential | R.T.
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Telephone | 254-666-6192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | R14566
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License Number State | TX
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