Healthcare Provider Details

I. General information

NPI: 1467944132
Provider Name (Legal Business Name): RENAISSANCE RADIOLOGY BILLING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JUPITER RD STE 107
PLANO TX
75074-6592
US

IV. Provider business mailing address

1018 N DAVIS DR
ARLINGTON TX
76012-3240
US

V. Phone/Fax

Practice location:
  • Phone: 817-896-6200
  • Fax: 817-549-9482
Mailing address:
  • Phone: 817-896-6200
  • Fax: 817-549-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MS. FELICIA A CRUZ
Title or Position: MANAGER
Credential:
Phone: 817-896-6200