Healthcare Provider Details

I. General information

NPI: 1649467747
Provider Name (Legal Business Name): DEAN SHIPPEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MAIN
LOVINGTON NM
88260
US

IV. Provider business mailing address

PO BOX 2175
PALESTINE TX
75802-2175
US

V. Phone/Fax

Practice location:
  • Phone: 505-396-7705
  • Fax:
Mailing address:
  • Phone: 903-731-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LIN STEWART
Title or Position: CEO
Credential:
Phone: 903-731-9300