MEDICARE: PRESTIGE 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1225204654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE IMAGING, LLC

Provider Business Mailing Address
First Line	:	6301 ABRAMS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-7818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6789 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7112
Country	:	US
Telephone Number	:	817-992-9989
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MR. BRADLEY SCOBLE
Credential	:
Telephone Number	:	817-992-9989

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	05/06/2008

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