MEDICARE: MONTICELLO DIAGNOSTIC IMAGING LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory
2	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1033160015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTICELLO DIAGNOSTIC IMAGING LP

Provider Business Mailing Address
First Line	:	7668 ELDORADO PKWY STE 200
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-5753
Country	:	US
Telephone Number	:	817-377-3800
Fax Number	:	817-377-3801

Provider Business Practice Location Address
First Line	:	3712 W 7TH ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-2536
Country	:	US
Telephone Number	:	817-377-3800
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMIN
Name	:	CHELSEA HOLDER
Credential	:
Telephone Number	:	817-377-3800

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	12/26/2024

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