MEDICARE: WHITE ROCK RADIOLOGY ASSOCIATES, L.L.P.

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CS3814	OTHER	TX	PALMETTO RAILROAD MEDICARE

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
2	K83D	OTHER	TX	BC BS TEXAS

General Provider Information

NPI Number	:	1891803888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE ROCK RADIOLOGY ASSOCIATES, L.L.P.

Provider Business Mailing Address
First Line	:	PO BOX 180065
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-0065
Country	:	US
Telephone Number	:	972-216-4411
Fax Number	:	972-216-7346

Provider Business Practice Location Address
First Line	:	10935 ESTATE LN
Second Line	:	#S126
City	:	DALLAS
State	:	TX
Zip	:	75238-2316
Country	:	US
Telephone Number	:	972-216-4411
Fax Number	:	972-216-7346

Authorized Official
Title or Position	:	OFFICER
Name	:	RANDOLPH TARBET LEONE
Credential	:	M.D.
Telephone Number	:	972-216-4411

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	09/14/2010

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Directions to “WHITE ROCK RADIOLOGY ASSOCIATES, L.L.P. ” Practice Location

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