MEDICARE: SHAFA MOBILE DIAGNOSTIC MANAGEMENT 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	261QR0208X	Mobile Radiology Clinic/Center
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1568865525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAFA MOBILE DIAGNOSTIC MANAGEMENT INC

Provider Business Mailing Address
First Line	:	2801 REGAL RD
Second Line	:	STE 110
City	:	PLANO
State	:	TX
Zip	:	75075-6315
Country	:	US
Telephone Number	:	972-612-2600
Fax Number	:	972-612-2602

Provider Business Practice Location Address
First Line	:	2801 REGAL RD
Second Line	:	STE 110
City	:	PLANO
State	:	TX
Zip	:	75075-6315
Country	:	US
Telephone Number	:	972-612-2600
Fax Number	:	972-612-2602

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MR. NIZAR ALIKHAN
Credential	:
Telephone Number	:	301-591-4184

Provider Enumeration Date	:	10/06/2014
Last Update Date	:	12/18/2014

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