1063768315 NPI number — DIAGNOSTIC EVALUATION CENTERS OF AMERICA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063768315 NPI number — DIAGNOSTIC EVALUATION CENTERS OF AMERICA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC EVALUATION CENTERS OF AMERICA
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:
1063768315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2850 SHORELINE TRL
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ROCKWALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75032-5513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-273-3395
Provider Business Mailing Address Fax Number:
469-273-3396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3334 N TOWN EAST BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150-3858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-693-7367
Provider Business Practice Location Address Fax Number:
469-273-3396
Provider Enumeration Date:
07/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCCLINTOCK
Authorized Official First Name:
JIMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-693-7367

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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