Healthcare Provider Details

I. General information

NPI: 1477933299
Provider Name (Legal Business Name): DIAGNOSTIC GROUP IMAGING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2015
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 COLLEGE ST SUITE 200
BEAUMONT TX
77701
US

IV. Provider business mailing address

3406 COLLEGE ST SUITE 200
BEAUMONT TX
77701-4612
US

V. Phone/Fax

Practice location:
  • Phone: 409-813-1677
  • Fax: 409-813-1699
Mailing address:
  • Phone: 409-813-1677
  • Fax: 409-813-1699

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: BRAD THIBODAUX
Title or Position: CHIEF DATA OFFICER
Credential:
Phone: 409-730-2022