Healthcare Provider Details

I. General information

NPI: 1235199829
Provider Name (Legal Business Name): MEDICAL CITY DALLAS IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN SUITE C-112
DALLAS TX
75230-2505
US

IV. Provider business mailing address

8300 W SUNRISE BLVD
PLANTATION FL
33322-5406
US

V. Phone/Fax

Practice location:
  • Phone: 469-757-1000
  • Fax:
Mailing address:
  • Phone: 754-206-6198
  • Fax:

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: TONI COOPER
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 754-206-6198