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General NPI Number Information
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NPI Number | 1518125574
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Entity Type | Organization
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Legal Business Name | PRESTIGE IMAGING, LLC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 6491 SOUTHWEST BLVD
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City | BENBROOK
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State | TX
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Zip | 76132-2777
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Country | US
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Telephone | 817-992-9989
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Fax |
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Provider Business Mailing Address
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Address Line | 6301 ABRAMS RD STE 131
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City | DALLAS
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State | TX
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Zip | 75231-7856
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | BRAD SCOBLE
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Credential |
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Telephone | 817-992-9989
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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 |
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