MEDICARE: ARA/ST. DAVID'S IMAGING, LP

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	261QR0200X	Radiology Clinic/Center	R28983	TX

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

General Provider Information

NPI Number	:	1417088295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARA/ST. DAVID'S IMAGING, LP

Provider Business Mailing Address
First Line	:	12554 RIATA VISTA CIR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-6431
Country	:	US
Telephone Number	:	512-795-5100
Fax Number	:	512-519-3451

Provider Business Practice Location Address
First Line	:	2501 W WILLIAM CANNON DR BLDG 5
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5253
Country	:	US
Telephone Number	:	512-346-7311
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	SHARLEE LEBLEU
Credential	:
Telephone Number	:	480-321-7026

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/10/2024

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