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General NPI Number Information
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NPI Number | 1467766550
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Entity Type | Organization
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Legal Business Name | USMD DIAGNOSTIC SERVICES, LLC
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 900 AIRPORT FREEWAY SUITE 132
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City | HURST
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State | TX
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Zip | 76054-3252
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Country | US
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Telephone | 817-514-5200
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Fax | 817-514-5210
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Provider Business Mailing Address
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Address Line | PO BOX 678168
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City | DALLAS
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State | TX
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Zip | 75267-8168
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Country | US
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Telephone | 972-847-0712
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Fax | 817-514-5246
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Authorized Official
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Title or Position | PRESIDENT PPM
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Name | MICHAEL W BUKOSKY
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Credential |
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Telephone | 817-514-5290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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