1861575615 NPI number — PREFERRED IMAGING OF PLANO, LLC

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 1861575615 NPI number — PREFERRED IMAGING OF PLANO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED IMAGING OF PLANO, 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:
1861575615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4511 N HIMES AVE STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33614-7073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-730-0050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2205 N CENTRAL EXPWY.
Provider Second Line Business Practice Location Address:
STE. 185
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75075-2591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-312-0799
Provider Business Practice Location Address Fax Number:
972-346-6566
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAMBILL
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
303-414-2037

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)

  • Identifier: P00605406 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205460101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0540DC . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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