Healthcare Provider Details

I. General information

NPI: 1568498491
Provider Name (Legal Business Name): CLEBURNE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HYDE PARK BLVD SUITE 200
CLEBURNE TX
76033-4537
US

IV. Provider business mailing address

106 HYDE PARK SUITE 200
CLEBURNE TX
76033-4537
US

V. Phone/Fax

Practice location:
  • Phone: 817-558-1940
  • Fax: 817-558-1960
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 StateTX

VIII. Authorized Official

Name: MATT H PURSER
Title or Position: PRESIDENT
Credential:
Phone: 469-916-8894