MEDICARE: CLEARSKY MRI & DIAGNOSTIC IMAGING CENTER OF N. DALLAS

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

General Provider Information

NPI Number	:	1265439939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARSKY MRI & DIAGNOSTIC IMAGING CENTER OF N. DALLAS

Provider Business Mailing Address
First Line	:	PO BOX 742225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75374-2225
Country	:	US
Telephone Number	:	972-669-3100
Fax Number	:	972-669-3101

Provider Business Practice Location Address
First Line	:	12606 GREENVILLE AVE
Second Line	:	SUITE 110
City	:	DALLAS
State	:	TX
Zip	:	75243-1921
Country	:	US
Telephone Number	:	972-669-3100
Fax Number	:	972-669-3101

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MS. KARIN CANNON
Credential	:	N/A
Telephone Number	:	972-669-3100

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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