Provider Demographics
NPI:1528680378
Name:SOUTH TEXAS RDI GROUP LLC
Entity type:Organization
Organization Name:SOUTH TEXAS RDI GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:OBLEPIAS
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:281-850-5325
Mailing Address - Street 1:5006 WATERBECK ST
Mailing Address - Street 2:
Mailing Address - City:WESTON LAKES
Mailing Address - State:TX
Mailing Address - Zip Code:77441-4143
Mailing Address - Country:US
Mailing Address - Phone:281-850-5325
Mailing Address - Fax:
Practice Address - Street 1:6630 FM 1463 RD STE 500-134
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7412
Practice Address - Country:US
Practice Address - Phone:281-850-5325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier