Provider Demographics
NPI:1487754438
Name:SAN BENITO IMAGING CENTER LP
Entity type:Organization
Organization Name:SAN BENITO IMAGING CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-399-2666
Mailing Address - Street 1:200 N SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4655
Mailing Address - Country:US
Mailing Address - Phone:956-399-2666
Mailing Address - Fax:956-399-2638
Practice Address - Street 1:200 N SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4655
Practice Address - Country:US
Practice Address - Phone:956-399-2666
Practice Address - Fax:956-399-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145921601Medicaid
FTA044Medicare ID - Type Unspecified