=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710490537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWDIC IMAGING CENTER PARTNERSHIP, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2017
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8230 WALNUT HILL LN STE 102
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-345-6905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8440 WALNUT HILL LN STE 520
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-345-4141
-----------------------------------------------------
Fax | 214-345-2099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF BUSINESS SERVICES
-----------------------------------------------------
Name | MR. PHILIP COLLINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-345-4141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | R18642
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------