=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942412630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DFW OPEN MRI, L.P.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 02/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10611 GARLAND RD #101
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75218-2666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-320-1400
-----------------------------------------------------
Fax | 214-320-1402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 740607
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75374-0607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-720-9944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BOB SHIELDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-720-9944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------