Healthcare Provider Details

I. General information

NPI: 1881881308
Provider Name (Legal Business Name): PRESTIGE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 N MIDKIFF RD SUITE C-8
MIDLAND TX
79705-4246
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 432-689-8770
  • Fax: 432-689-8379
Mailing address:
  • Phone: 469-916-8894
  • Fax: 469-916-8897

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: MS. KIM D CRUZ
Title or Position: FACILITY DIRECTOR
Credential:
Phone: 817-558-1940