Healthcare Provider Details

I. General information

NPI: 1083642656
Provider Name (Legal Business Name): PRESTIGE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 N SAM RAYBURN FWY SUITE 610
SHERMAN TX
75090-2546
US

IV. Provider business mailing address

2916 N SAM RAYBURN FWY SUITE 610
SHERMAN TX
75090-2546
US

V. Phone/Fax

Practice location:
  • Phone: 903-868-2255
  • Fax: 903-868-8011
Mailing address:
  • Phone: 903-868-2255
  • Fax: 903-868-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberR29470
License Number StateTX

VIII. Authorized Official

Name: MS. KIM D CRUZ
Title or Position: FACILITY DIRECTOR
Credential:
Phone: 817-558-1940