Provider Demographics
NPI:1205897360
Name:HIGH PLAINS RADIOLOGICAL ASSOC LLP
Entity type:Organization
Organization Name:HIGH PLAINS RADIOLOGICAL ASSOC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE AO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-355-3352
Mailing Address - Street 1:PO BOX 3780
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-3780
Mailing Address - Country:US
Mailing Address - Phone:806-355-3352
Mailing Address - Fax:
Practice Address - Street 1:1901 MEDI PARK
Practice Address - Street 2:STE 2050
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-355-3352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100750680AMedicaid
NMG3064Medicaid
TX00M322OtherBLUE CROSS
TX109473201Medicaid
TX00M322Medicare ID - Type Unspecified
NM700521064Medicare ID - Type Unspecified
TX00M322OtherBLUE CROSS