Healthcare Provider Details

I. General information

NPI: 1740752211
Provider Name (Legal Business Name): TEXAS DIAGNOSTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 PRESTON RD STE 350-321
PLANO TX
75093-7453
US

IV. Provider business mailing address

3308 PRESTON RD STE 350-321
PLANO TX
75093-7453
US

V. Phone/Fax

Practice location:
  • Phone: 469-931-0684
  • Fax: 469-931-0712
Mailing address:
  • Phone: 469-931-0684
  • Fax: 469-931-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY MCAULIFF
Title or Position: OWNER
Credential: MD
Phone: 469-931-0684