MEDICARE: DIAGNOSTIC IMAGE PLUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	246XS1301X	Sonography Specialist/Technologist Cardiovascular	TX
2	247100000X	Radiologic Technologist	TX
3	2471B0102X	Bone Densitometry Radiologic Technologist
4	2471C3402X	Radiography Radiologic Technologist
5	2471S1302X	Sonography Radiologic Technologist	TX
6	2471V0105X	Vascular Sonography Radiologic Technologist	TX
7	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FTXVCU1	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689781130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC IMAGE PLUS

Provider Business Mailing Address
First Line	:	3022 MOTLEY DR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-3440
Country	:	US
Telephone Number	:	972-613-0555
Fax Number	:	972-613-0546

Provider Business Practice Location Address
First Line	:	3022 MOTLEY DR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-3440
Country	:	US
Telephone Number	:	972-613-0555
Fax Number	:	972-613-0546

Authorized Official
Title or Position	:	OPERATIONS DIRECTOR
Name	:	MR. VARGHESE RAJU
Credential	:	M.A,.B.ED
Telephone Number	:	972-613-0555

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	06/22/2021

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Directions to “DIAGNOSTIC IMAGE PLUS ” Practice Location

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