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General NPI Number Information
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NPI Number | 1114485042
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Entity Type | Organization
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Legal Business Name | MCI DIAGNOSTIC CENTER, LLC
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 1155 KAS DR STE 180
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City | RICHARDSON
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State | TX
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Zip | 75081-1970
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Country | US
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Telephone | 469-485-2382
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Fax | 833-390-1352
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Provider Business Mailing Address
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Address Line | 1155 KAS DR STE 180
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City | RICHARDSON
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State | TX
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Zip | 75081-1970
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Country | US
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Telephone | 469-485-2382
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Fax | 833-390-1352
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Authorized Official
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Title or Position | COO
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Name | COLLEEN PAYNE
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Credential |
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Telephone | 469-485-2382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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