Healthcare Provider Details

I. General information

NPI: 1538219290
Provider Name (Legal Business Name): LONE STAR RADIOLOGY MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N BUCKNER BLVD STE 104
DALLAS TX
75218-2764
US

IV. Provider business mailing address

PO BOX 67118
DALLAS TX
75267-1188
US

V. Phone/Fax

Practice location:
  • Phone: 214-660-0800
  • Fax: 214-660-0804
Mailing address:
  • Phone: 214-378-4499
  • 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: DR. THOMAS RHUDY
Title or Position: CHIEF OF STAFF
Credential: DC
Phone: 214-378-4499