Healthcare Provider Details

I. General information

NPI: 1649018011
Provider Name (Legal Business Name): ALLIANCE DIAGNOSTIC IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 N TARRANT PKWY STE 400
FORT WORTH TX
76177-8631
US

IV. Provider business mailing address

5616 WARREN PKWY STE 102
FRISCO TX
75034-4166
US

V. Phone/Fax

Practice location:
  • Phone: 214-762-9084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PRAKASH KRISHNARAJ
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-762-9084