Organization
BRAZOS MOBILE IMAGING,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABBAS RAHIMI BSRT, RTR (PRESIDENT)
(254) 772-8248
Entity
Organization
Contact information
Practice address
208 CHAMA DR, HEWITT, TX 76643-3368
(254) 772-8248
(254) 870-1991
Mailing address
PO BOX 21265, WACO, TX 76702-1265
(254) 772-8248
(254) 772-8457
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
R21052
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086096702
—
TX
01
—
459851
BCBS PROVIDER NUMBER
TX
01
—
630000698
PALMETTO GBA NUMBER
TX
Enumeration date
08/10/2006
Last updated
08/31/2020
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