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General NPI Number Information
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NPI Number | 1962645408
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Entity Type | Organization
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Legal Business Name | COMANCHE COUNTY HOSPITAL AUTHORITY SOUTHWEST RADIOLOGY
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 522 DETROIT ST
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City | DENVER
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State | CO
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Zip | 80206-4314
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Country | US
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Telephone | 800-945-2455
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1017
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City | GREENVILLE
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State | TX
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Zip | 75403-1017
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Country | US
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Telephone | 972-664-6956
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Fax | 770-237-1831
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Authorized Official
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Title or Position | SENIOR DIRECTOR
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Name | JOE K CUMMINS
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Credential |
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Telephone | 580-510-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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