MEDICARE: TARRANT MEDICAL IMAGING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1093718033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRANT MEDICAL IMAGING, LLC

Provider Business Mailing Address
First Line	:	1894 GEORGETOWN RD
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-4058
Country	:	US
Telephone Number	:	330-653-3968
Fax Number	:	330-656-1660

Provider Business Practice Location Address
First Line	:	1600 CENTRAL DR
Second Line	:	STE 195
City	:	BEDFORD
State	:	TX
Zip	:	76022-6067
Country	:	US
Telephone Number	:	817-267-0777
Fax Number	:	817-267-8878

Authorized Official
Title or Position	:	DIRECTOR OF BILLING
Name	:	MS. V. RENAE COYNE
Credential	:
Telephone Number	:	330-653-3968

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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