=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386864007
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ECLIPSE MEDICAL IMAGING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6805 NE LOOP 820 407
-----------------------------------------------------
City | NORTH RICHLAND HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76180-6687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-581-4354
-----------------------------------------------------
Fax | 817-581-4364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6805 NE LOOP 820 407
-----------------------------------------------------
City | NORTH RICHLAND HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76180-6687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-581-4354
-----------------------------------------------------
Fax | 817-581-4364
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMES WALLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-891-6744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------