Organization
OUTPATIENT IMAGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM MATTHIAS BOUSHKA MD (OWNER)
(505) 532-8800
Entity
Organization
Contact information
Practice address
6065 MONTANA AVE, STE. A-6, EL PASO, TX 79925-1835
(505) 532-8800
(505) 532-5920
Mailing address
3850 FOOTHILLS RD, STE. 9, LAS CRUCES, NM 88011-4632
(505) 532-8800
(505) 532-5920
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J0750
TX
Other
Enumeration date
07/11/2006
Last updated
12/03/2007
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