Organization
WACO RADIOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP MALONE (OPERATIONS MANGER)
(405) 321-8125
Entity
Organization
Contact information
Practice address
405 LONDONDERRY DR, STE 104, WACO, TX 76712-7924
(469) 757-1000
Mailing address
PO BOX 103, ROCKWALL, TX 75087-0103
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C377
BLUE CROSS BLUE SHIELD OF TEXAS
TX
05
—
081864301
—
TX
Enumeration date
03/27/2006
Last updated
07/17/2008
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