1104191568 NPI number — TOUCHSTONE IMAGING OF MESQUITE, LP

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 1104191568 NPI number — TOUCHSTONE IMAGING OF MESQUITE, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOUCHSTONE IMAGING OF MESQUITE, LP
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:
6
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:
1104191568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5214 MARYLAND WAY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-661-9200
Provider Business Mailing Address Fax Number:
615-661-9297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-4306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-336-4637
Provider Business Practice Location Address Fax Number:
817-336-7719
Provider Enumeration Date:
03/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RICE
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
615-661-9200

Provider Taxonomy Codes

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

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





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