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General NPI Number Information
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NPI Number | 1700394392
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Entity Type | Organization
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Legal Business Name | BLUE STONE FRISCO JV, LLP
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 3800 GAYLORD PKWY STE 150
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City | FRISCO
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State | TX
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Zip | 75034-9418
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Country | US
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Telephone | 972-497-4100
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Fax | 972-497-4104
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Provider Business Mailing Address
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Address Line | PO BOX 746509
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City | ATLANTA
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State | GA
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Zip | 30374-6509
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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 | DIRECTOR OF CREDENTIALING
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Name | KATRINA ROELLE
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Credential |
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Telephone | 614-689-1691
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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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Taxonomy #2
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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