MEDICARE: COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1306933098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC

Provider Business Mailing Address
First Line	:	600 CONGRESS AVE
Second Line	:	SUITE 2150
City	:	AUSTIN
State	:	TX
Zip	:	78701-2991
Country	:	US
Telephone Number	:	512-370-8100
Fax Number	:	512-370-8198

Provider Business Practice Location Address
First Line	:	800 5TH AVE
Second Line	:	SUITE 400
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7305
Country	:	US
Telephone Number	:	817-924-1999
Fax Number	:	817-886-0881

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. EILEEN KANEWSKE
Credential	:
Telephone Number	:	512-370-8114

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	04/09/2008

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