MEDICARE: MAXUM HEALTH SERVICES CORP.

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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1780998922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXUM HEALTH SERVICES CORP.

Provider Business Mailing Address
First Line	:	PO BOX 848074
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8074
Country	:	US
Telephone Number	:	817-335-5370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 8TH AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-4102
Country	:	US
Telephone Number	:	817-335-5370
Fax Number	:	817-877-3868

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER; TREASURER
Name	:	JAMES F. STANLEY
Credential	:
Telephone Number	:	94928260000

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	08/20/2012

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