Healthcare Provider Details

I. General information

NPI: 1326225707
Provider Name (Legal Business Name): PARK CENTRAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 GRANITE PKWY STE 460
PLANO TX
75024-6654
US

IV. Provider business mailing address

5601 GRANITE PKWY STE 460
PLANO TX
75024-6654
US

V. Phone/Fax

Practice location:
  • Phone: 469-362-6909
  • Fax:
Mailing address:
  • Phone: 469-362-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: TAMMY SAKURADA
Title or Position: BILLING
Credential:
Phone: 972-479-1115