1568521680 NPI number — RADIOLOGY ASSOCIATES OF NORTH TEXAS PA

Table of content: (NPI 1568521680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568521680 NPI number — RADIOLOGY ASSOCIATES OF NORTH TEXAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY ASSOCIATES OF NORTH TEXAS PA
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:
WEATHERFORD IMAGING CENTER
Provider Other Organization Name Type Code:
5
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:
1568521680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
816 W CANNON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-3146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-321-0387
Provider Business Mailing Address Fax Number:
817-317-7033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1429 CLEAR LAKE RD
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
WEATHERFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76086-5805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-321-0312
Provider Business Practice Location Address Fax Number:
817-317-7033
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUERALT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-321-0312

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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