Healthcare Provider Details

I. General information

NPI: 1184666588
Provider Name (Legal Business Name): PRESTIGE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 ABRAMS RD SUITE 131
DALLAS TX
75231-7818
US

IV. Provider business mailing address

6301 ABRAMS RD SUITE 131
DALLAS TX
75231-7818
US

V. Phone/Fax

Practice location:
  • Phone: 469-916-8894
  • Fax: 469-916-8897
Mailing address:
  • Phone: 469-916-8894
  • Fax: 469-916-8897

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: MS. ROSE STALCUP
Title or Position: OFFICE MANAGER
Credential:
Phone: 469-916-8894