Healthcare Provider Details

I. General information

NPI: 1831516947
Provider Name (Legal Business Name): WELLNESS DIAGNOSTIC FIRST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 MIDWAY RD STE 250
PLANO TX
75093-8116
US

IV. Provider business mailing address

PO BOX 495
MIDLOTHIAN TX
76065-0495
US

V. Phone/Fax

Practice location:
  • Phone: 817-461-6374
  • Fax: 817-461-8550
Mailing address:
  • Phone: 817-461-6374
  • Fax: 817-461-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberL7564
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberL7564
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID SLATER
Title or Position: DIRECTOR
Credential: M.D.
Phone: 817-461-6374