Healthcare Provider Details

I. General information

NPI: 1043362916
Provider Name (Legal Business Name): PRESTIGE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 N JOSEY LN
CARROLLTON TX
75010-4615
US

IV. Provider business mailing address

106 HYDE PARK BLVD SUITE 102
CLEBURNE TX
76033-4523
US

V. Phone/Fax

Practice location:
  • Phone: 972-492-1334
  • Fax: 972-492-7909
Mailing address:
  • Phone: 817-558-1940
  • Fax: 817-558-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KIM D CRUZ
Title or Position: FACILITY DIRECTOR
Credential: LVN
Phone: 817-558-1940