MEDICARE: CROSS DIAGNOSTIC IMAGING INC

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	247100000X	Radiologic Technologist		TX

General Provider Information

NPI Number	:	1508101718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSS DIAGNOSTIC IMAGING INC

Provider Business Mailing Address
First Line	:	568 ROBIN RD
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-6405
Country	:	US
Telephone Number	:	214-337-6513
Fax Number	:	214-337-3300

Provider Business Practice Location Address
First Line	:	2701 S HAMPTON RD STE 140
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-2363
Country	:	US
Telephone Number	:	214-337-6513
Fax Number	:	214-337-3300

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. STEPHANIE BO BECHO
Credential	:	B.S.
Telephone Number	:	214-337-6513

Provider Enumeration Date	:	11/29/2012
Last Update Date	:	11/29/2012

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