MEDICARE: E PLUS PET IMAGING XII LP

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	261QR0200X	Radiology Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00262810	OTHER		RRMEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0462DC	OTHER	TX	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1619922184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E PLUS PET IMAGING XII LP

Provider Business Mailing Address
First Line	:	1250 NORTHWEST HWY STE R
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-5842
Country	:	US
Telephone Number	:	972-279-5172
Fax Number	:	972-279-6948

Provider Business Practice Location Address
First Line	:	1250 R NORTHWEST HIGHWAY
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-5851
Country	:	US
Telephone Number	:	972-279-5172
Fax Number	:	972-279-6948

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT & CFO
Name	:	CHAOQIANG LIN
Credential	:
Telephone Number	:	214-587-4079

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	12/15/2025

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