Brazos Mobile Imaging,Inc.

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

License

R21052 Issued in TX

Legal business name

BRAZOS MOBILE IMAGING,INC.

Practice address

208 Chama Dr
Hewitt, TX 76643-3368

Phone

(254) 772-8248

Fax

(254) 870-1991

NPI assigned

Aug 10, 2006

Last updated

Aug 31, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abbas Rahimi, BSRT, RTR

Title

President

Phone

(254) 772-8248

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598832000000",
    "number": "1447261219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21265",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767021265",
            "telephone_number": "254-772-8248",
            "fax_number": "254-772-8457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 CHAMA DR",
            "city": "HEWITT",
            "state": "TX",
            "postal_code": "766433368",
            "telephone_number": "254-772-8248",
            "fax_number": "254-870-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOS MOBILE IMAGING,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A",
        "authorized_official_last_name": "RAHIMI",
        "authorized_official_first_name": "ABBAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "254-772-8248",
        "authorized_official_credential": "BSRT, RTR"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "TX",
            "license": "R21052",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "459851",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086096702",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA NUMBER",
            "identifier": "630000698",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julian Omar Ayala Morales, D.C.
• A. Alexander Beaujean, PHD
• Nicholas Frank Benson, PHD
• Karen Denise Bostick, M.ED., L.P.C.
• Brazos Healthcare Partners, LLC
• Courtney Broaddus, M.S.
• Toni L Brooker
• Heather Nicole Brown, SLP
• Selena Byman
• Marcella Caldwell

• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Hewitt, TX
• Providers in Hewitt, TX by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.