MEDICARE: PRESTIGE IMAGING, LLC

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	261QR0200X	Radiology Clinic/Center	R29470	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00305755	OTHER	TX	MEDICARE RAIL ROAD

General Provider Information

NPI Number	:	1083642656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE IMAGING, LLC

Provider Business Mailing Address
First Line	:	2916 N SAM RAYBURN FWY
Second Line	:	SUITE 610
City	:	SHERMAN
State	:	TX
Zip	:	75090-2546
Country	:	US
Telephone Number	:	903-868-2255
Fax Number	:	903-868-8011

Provider Business Practice Location Address
First Line	:	2916 N SAM RAYBURN FWY
Second Line	:	SUITE 610
City	:	SHERMAN
State	:	TX
Zip	:	75090-2546
Country	:	US
Telephone Number	:	903-868-2255
Fax Number	:	903-868-8011

Authorized Official
Title or Position	:	FACILITY DIRECTOR
Name	:	MS. KIM D CRUZ
Credential	:
Telephone Number	:	817-558-1940

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	04/15/2008

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Directions to “PRESTIGE IMAGING, LLC ” Practice Location

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