MEDICARE: AMERICAN DYNAMIC IMAGING LTD

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center		TX
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00234833	OTHER	TX	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0543DC	OTHER	TX	BCBS PIN

General Provider Information

NPI Number	:	1871676643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DYNAMIC IMAGING LTD

Provider Business Mailing Address
First Line	:	797 LONESOME DOVE TRL
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76054-6018
Country	:	US
Telephone Number	:	817-577-7500
Fax Number	:	817-577-7501

Provider Business Practice Location Address
First Line	:	9627 HUEBNER RD.
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1662
Country	:	US
Telephone Number	:	210-690-3400
Fax Number	:	210-690-3407

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. GAY G WALTERS
Credential	:
Telephone Number	:	817-577-7500

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	02/10/2016

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Directions to “AMERICAN DYNAMIC IMAGING LTD ” Practice Location

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