Organization
AMERICAN DYNAMIC IMAGING LTD
Active
Other names
Physicians Stand Up MRI LTD
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GAY G WALTERS (PRESIDENT)
(817) 577-7500
Entity
Organization
Contact information
Practice address
9627 HUEBNER RD., SUITE 100, SAN ANTONIO, TX 78240-1662
(210) 690-3400
(210) 690-3407
Mailing address
797 LONESOME DOVE TRL, HURST, TX 76054-6018
(817) 577-7500
(817) 577-7501
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
TX
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0543DC
BCBS PIN
TX
01
—
P00234833
RAILROAD MEDICARE PIN
TX
Enumeration date
10/23/2006
Last updated
02/10/2016
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