MEDICARE: SPECIALTY IMAGING CONSULTANTS 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1174131049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY IMAGING CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	4320 WESTWAY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-3728
Country	:	US
Telephone Number	:	214-693-8134
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 WESTWAY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-3728
Country	:	US
Telephone Number	:	214-693-8134
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES SCHROEDER
Credential	:	MD
Telephone Number	:	214-693-8134

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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