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NPI Code Detail

MEDICARE: MSK DIAGNOSTICS LLC

MEDICARE: MSK DIAGNOSTICS 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
1174400000XSpecialist

General Provider Information

NPI Number : 1710436191
Entity Type Code : Organization
Provider Name (Legal Business Name) : MSK DIAGNOSTICS LLC
Provider Business Mailing Address
First Line : 3160 N TARRANT PKWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76177-8614
Country : US
Telephone Number : 469-814-8244
Fax Number :
Provider Business Practice Location Address
First Line : 3160 N TARRANT PKWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76177-8614
Country : US
Telephone Number : 469-814-8244
Fax Number :
Authorized Official
Title or Position : MBR
Name : MARK C VALENTE
Credential :
Telephone Number : 972-707-0005
Provider Enumeration Date : 09/27/2016
Last Update Date : 09/27/2016

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Directions to “MSK DIAGNOSTICS LLC ” Practice Location

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