1326219817 NPI number — BDNT RADIOLOGY, PA

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 1326219817 NPI number — BDNT RADIOLOGY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BDNT RADIOLOGY, 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:
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:
1326219817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 92038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-749-2001
Provider Business Mailing Address Fax Number:
940-483-1568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2817 S MAYHILL RD STE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76208-5970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-749-2001
Provider Business Practice Location Address Fax Number:
940-483-1568
Provider Enumeration Date:
03/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VENUGOPAL
Authorized Official First Name:
RAVI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
817-749-2001

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00627Z . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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