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General NPI Number Information
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NPI Number | 1972694099
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Entity Type | Organization
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Legal Business Name | MEDICAL IMAGING OF DALLAS, LLP
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 102 DECKER CT STE 205
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City | IRVING
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State | TX
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Zip | 75062-2740
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Country | US
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Telephone | 972-906-6250
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Fax | 972-906-0116
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Provider Business Mailing Address
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Address Line | PO BOX 814129
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City | DALLAS
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State | TX
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Zip | 75381-4129
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Country | US
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Telephone | 972-906-6250
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Fax | 972-906-0116
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BRIDGET HAYNES
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Credential |
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Telephone | 972-906-6276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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