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General NPI Number Information
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NPI Number | 1083642656
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Entity Type | Organization
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Legal Business Name | PRESTIGE IMAGING, LLC
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 2916 N SAM RAYBURN FWY SUITE 610
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City | SHERMAN
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State | TX
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Zip | 75090-2546
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Country | US
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Telephone | 903-868-2255
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Fax | 903-868-8011
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Provider Business Mailing Address
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Address Line | 2916 N SAM RAYBURN FWY SUITE 610
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City | SHERMAN
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State | TX
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Zip | 75090-2546
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Country | US
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Telephone | 903-868-2255
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Fax | 903-868-8011
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Authorized Official
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Title or Position | FACILITY DIRECTOR
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Name | MS. KIM D CRUZ
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Credential |
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Telephone | 817-558-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | R29470
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License Number State | TX
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