1306039078 NPI number — ENVISION DIAGNOSTIC ULTRASOUND IMAGING

Table of content: (NPI 1306039078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306039078 NPI number — ENVISION DIAGNOSTIC ULTRASOUND IMAGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENVISION DIAGNOSTIC ULTRASOUND 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:
ENVISION DIAGNOSTIC ULTRASOUND 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:
1306039078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 542767
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75054-2767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-951-5151
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3125 S CARRIER PKWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75052-3735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-262-9000
Provider Business Practice Location Address Fax Number:
972-262-9306
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOUSTON
Authorized Official First Name:
LUTHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
214-951-5151

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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