MEDICARE: NORTH TEXAS RADIOLOGY PLLC

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	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1760422513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS RADIOLOGY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1888
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75403
Country	:	US
Telephone Number	:	800-945-2455
Fax Number	:	903-453-2541

Provider Business Practice Location Address
First Line	:	3712 W 7TH STREET
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76107
Country	:	US
Telephone Number	:	817-738-6571
Fax Number	:	817-738-6573

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK A BAKER
Credential	:	DO
Telephone Number	:	817-738-6571

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	05/14/2008

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