Healthcare Provider Details

I. General information

NPI: 1750626628
Provider Name (Legal Business Name): MVP BURLESON LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 NE ALSBURY BLVD STE 101
BURLESON TX
76028-2660
US

IV. Provider business mailing address

550 BAILEY AVE STE 750
FT WORTH TX
76107-2175
US

V. Phone/Fax

Practice location:
  • Phone: 817-886-8919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: APRIL SAWYER
Title or Position: SR DIR OF REV CYCLE MGMT
Credential:
Phone: 817-202-5179