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General NPI Number Information
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NPI Number | 1639180797
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Entity Type | Organization
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Legal Business Name | GRAPEVINE IMAGING & PAIN MANAGEMENT CENTER LLC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 2401 IRA E WOODS #600
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City | GRAPEVINE
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State | TX
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Zip | 76051-8631
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Country | US
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Telephone | 817-488-9991
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Fax | 817-488-9992
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Provider Business Mailing Address
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Address Line | 2401 IRA E WOODS #600
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City | GRAPEVINE
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State | TX
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Zip | 76051-8631
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Country | US
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Telephone | 817-488-9991
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Fax | 817-488-9992
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Authorized Official
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Title or Position | CEO/MANAGING MEMBER
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Name | MR. GAIL S. MAYFIELD
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Credential |
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Telephone | 817-479-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R25579
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License Number State | TX
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