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General NPI Number Information
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NPI Number | 1245456219
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Entity Type | Organization
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Legal Business Name | WELLMART HEARTLAB INC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 349 LAS COLINAS BLVD E SUITE C
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City | IRVING
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State | TX
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Zip | 75039-5557
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Country | US
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Telephone | 972-739-2840
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Fax | 972-739-2854
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Provider Business Mailing Address
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Address Line | 349 LAS COLINAS BLVD E SUITE C
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City | IRVING
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State | TX
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Zip | 75039-5557
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Country | US
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Telephone | 972-739-2840
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Fax | 972-739-2854
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Authorized Official
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Title or Position | CEO
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Name | JOHN DUNCAN
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Credential |
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Telephone | 972-739-2840
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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 |
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License Number State | TX
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