Healthcare Provider Details

I. General information

NPI: 1972941326
Provider Name (Legal Business Name): BTDI JV LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 6TH AVE
FORT WORTH TX
76104-4306
US

IV. Provider business mailing address

1101 6TH AVE
FORT WORTH TX
76104-4306
US

V. Phone/Fax

Practice location:
  • Phone: 817-336-4637
  • Fax:
Mailing address:
  • Phone: 817-336-4637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: CLETE D MADDEN
Title or Position: PRESIDENT
Credential:
Phone: 615-661-9200