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General NPI Number Information
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NPI Number | 1649018011
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Entity Type | Organization
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Legal Business Name | ALLIANCE DIAGNOSTIC IMAGING LLC
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Dates
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Enumeration Date | 07/18/2024
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 3160 N TARRANT PKWY STE 400
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City | FORT WORTH
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State | TX
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Zip | 76177-8631
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Country | US
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Telephone | 214-762-9084
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Fax |
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Provider Business Mailing Address
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Address Line | 5616 WARREN PKWY STE 102
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City | FRISCO
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State | TX
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Zip | 75034-4166
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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 | ADMINISTRATOR
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Name | MR. PRAKASH KRISHNARAJ
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Credential |
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Telephone | 214-762-9084
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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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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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