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General NPI Number Information
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NPI Number | 1144411570
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Entity Type | Organization
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Legal Business Name | FORT WORTH I ENTERPRISES, LLC DBA HEALTHY IMAGES OF TEXAS
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 4150 INTERNATIONAL PLZ STE 600
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City | FORT WORTH
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State | TX
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Zip | 76109-4831
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Country | US
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Telephone | 512-992-7712
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Fax | 512-262-0869
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Provider Business Mailing Address
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Address Line | 4150 INTERNATIONAL PLZ STE 600
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City | FORT WORTH
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State | TX
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Zip | 76109-4831
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Country | US
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Telephone | 512-992-7712
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Fax | 512-262-0869
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY BLAKE
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Credential |
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Telephone | 512-992-7712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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