Healthcare Provider Details

I. General information

NPI: 1720249063
Provider Name (Legal Business Name): 3D CLEARSITE DIAGNOSTIC IMAGING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 COIT RD SUITE 240
PLANO TX
75025-5833
US

IV. Provider business mailing address

9720 COIT RD SUITE 240
PLANO TX
75025-5833
US

V. Phone/Fax

Practice location:
  • Phone: 214-872-1882
  • Fax: 214-872-1884
Mailing address:
  • Phone: 214-872-1882
  • Fax: 214-872-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number16394
License Number StateTX

VIII. Authorized Official

Name: TRAVIS HARRISON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 214-872-1882