=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629215249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KANDID IMAGING, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2009
-----------------------------------------------------
Last Update Date | 01/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 WINDSOR CENTRE TRAIL SUITE 300
-----------------------------------------------------
City | FLOWER MOUND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75028-1557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-316-4448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4320 WINDSOR CENTRE TRAIL SUITE 300
-----------------------------------------------------
City | FLOWER MOUND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75028-1557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-316-4448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KANDACE B FARMER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 972-316-4448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------