1508863143 NPI number — NORTH DALLAS MEDICAL IMAGING

Table of content: (NPI 1508863143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508863143 NPI number — NORTH DALLAS MEDICAL IMAGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH DALLAS MEDICAL IMAGING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED MEDICAL IMAGING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508863143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601449
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75360-1449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-368-9966
Provider Business Mailing Address Fax Number:
214-368-9977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12800 PRESTON RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75230-1367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-458-6888
Provider Business Practice Location Address Fax Number:
972-458-0777
Provider Enumeration Date:
06/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GHANI
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
972-458-6888

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0283DC . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".