Healthcare Provider Details

I. General information

NPI: 1164608923
Provider Name (Legal Business Name): PRESTIGE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 JUDSON RD
LONGVIEW TX
75605-1803
US

IV. Provider business mailing address

6301 ABRAMS RD SUITE 131B
DALLAS TX
75231-7818
US

V. Phone/Fax

Practice location:
  • Phone: 903-663-0110
  • Fax:
Mailing address:
  • Phone: 469-916-8894
  • Fax:

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: KIMBERLY DAWN CRUZ
Title or Position: FACILITY DIRECTOR
Credential:
Phone: 817-558-1940