Healthcare Provider Details

I. General information

NPI: 1467766550
Provider Name (Legal Business Name): USMD DIAGNOSTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 AIRPORT FREEWAY SUITE 132
HURST TX
76054-3252
US

IV. Provider business mailing address

PO BOX 678168
DALLAS TX
75267-8168
US

V. Phone/Fax

Practice location:
  • Phone: 817-514-5200
  • Fax: 817-514-5210
Mailing address:
  • Phone: 972-847-0712
  • Fax: 817-514-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W BUKOSKY
Title or Position: PRESIDENT PPM
Credential:
Phone: 817-514-5290