Healthcare Provider Details

I. General information

NPI: 1114246311
Provider Name (Legal Business Name): COLLIN COUNTY IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 INDEPENDENCE PKWY SUITE 312
PLANO TX
75023-5463
US

IV. Provider business mailing address

5501 INDEPENDENCE PKWY SUITE 312
PLANO TX
75023-5463
US

V. Phone/Fax

Practice location:
  • Phone: 972-964-1415
  • Fax: 972-964-7208
Mailing address:
  • Phone: 972-964-1415
  • Fax: 972-964-7208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number18244
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERT J LUGO
Title or Position: DR.
Credential: DDS, DMD
Phone: 972-964-1415