MEDICARE: M&S RADIOLOGY ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265423693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M&S RADIOLOGY ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	DEPT D8288
Second Line	:	P O BOX 650002
City	:	DALLAS
State	:	TX
Zip	:	75265-0282
Country	:	US
Telephone Number	:	800-666-1816
Fax Number	:	706-653-5917

Provider Business Practice Location Address
First Line	:	8715 VILLAGE DR STE 320
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5407
Country	:	US
Telephone Number	:	210-858-8019
Fax Number	:	210-455-0169

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHILLIP FORTENBERRY
Credential	:	M.D.
Telephone Number	:	210-892-0228

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	12/20/2022

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