Basic Information
| Provider Information | |||||||||
| NPI: | 1275521718 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST RADIOLOGY ASSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7026 OLD KATY RD | ||||||||
| Address2: | STE 276 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136217436 | ||||||||
| FaxNumber: | 7139639051 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 MEDICAL CENTER BLVD | ||||||||
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| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136217436 | ||||||||
| FaxNumber: | 7139639051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOHNN | ||||||||
| AuthorizedOfficialFirstName: | BYRON | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7136217436 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.