1659698587 NPI number — PREFERRED IMAGING OF DENTON, LLC

Table of content: (NPI 1659698587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659698587 NPI number — PREFERRED IMAGING OF DENTON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED IMAGING OF DENTON, LLC
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:
Provider Other Organization Name Type Code:
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:
1659698587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 674195
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:
75267-4195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-479-1115
Provider Business Mailing Address Fax Number:
972-479-1118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1614 SCRIPTURE ST
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76201-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-387-6159
Provider Business Practice Location Address Fax Number:
940-382-3875
Provider Enumeration Date:
05/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KASSA
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VICE PRESIDENT
Authorized Official Telephone Number:
904-515-0362

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00914666 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0761DC . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 220125301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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