Provider Demographics
NPI:1447261219
Name:BRAZOS MOBILE IMAGING,INC.
Entity type:Organization
Organization Name:BRAZOS MOBILE IMAGING,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:BSRT, RTR
Authorized Official - Phone:254-772-8248
Mailing Address - Street 1:PO BOX 21265
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-1265
Mailing Address - Country:US
Mailing Address - Phone:254-772-8248
Mailing Address - Fax:254-772-8457
Practice Address - Street 1:208 CHAMA DR
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3368
Practice Address - Country:US
Practice Address - Phone:254-772-8248
Practice Address - Fax:254-870-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207T00000X
TXR21052335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459851OtherBCBS PROVIDER NUMBER
TX630000698OtherPALMETTO GBA NUMBER
TX086096702Medicaid
TX459887Medicare PIN