Healthcare Provider Details

I. General information

NPI: 1609093368
Provider Name (Legal Business Name): PRAIRIE HEALTH SERVICES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 OAKWOOD CT
FLOWER MOUND TX
75028-3694
US

IV. Provider business mailing address

503 W HARWOOD RD
HURST TX
76054-3163
US

V. Phone/Fax

Practice location:
  • Phone: 469-867-1435
  • Fax:
Mailing address:
  • Phone: 817-282-9992
  • Fax: 817-282-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURENCE FRAYNE
Title or Position: CEO
Credential:
Phone: 817-282-9992