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General NPI Number Information
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NPI Number | 1841742038
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Entity Type | Organization
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Legal Business Name | METHODIST-CDI
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 2975 E BROAD ST STE 101
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City | MANSFIELD
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State | TX
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Zip | 76063-9185
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Country | US
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Telephone | 214-420-5445
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Fax | 817-453-8082
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Provider Business Mailing Address
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Address Line | 5775 WAYZATA BLVD SUITE 400
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1222
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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 | SPECIAL ASSISTANT SECRETARY
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Name | SUSAN C HOLMAN
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Credential |
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Telephone | 952-513-6831
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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 |
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License Number State |
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