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General NPI Number Information
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NPI Number | 1073604195
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 1250 8TH AVE #130
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City | FORT WORTH
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State | TX
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Zip | 76104-4124
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Country | US
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Telephone | 817-886-0880
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Fax | 817-924-9349
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Provider Business Mailing Address
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Address Line | 15601 DALLAS PKWY STE. 500
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City | ADDISON
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State | TX
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Zip | 75001-3353
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Country | US
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Telephone | 469-398-4100
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Fax | 469-398-4189
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES POLFREMAN
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Credential |
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Telephone | 469-398-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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