Healthcare Provider Details

I. General information

NPI: 1205786258
Provider Name (Legal Business Name): BEACON IR CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WESTPARK WAY
EULESS TX
76040-3957
US

IV. Provider business mailing address

PO BOX 524
COLLEYVILLE TX
76034-0524
US

V. Phone/Fax

Practice location:
  • Phone: 833-473-6248
  • Fax: 833-473-6248
Mailing address:
  • Phone: 833-473-6248
  • Fax: 833-473-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LUKE A CARLSON
Title or Position: OWNER
Credential: MD
Phone: 833-473-6248