1891803888 NPI number — WHITE ROCK RADIOLOGY ASSOCIATES, L.L.P.

Table of content: (NPI 1891803888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891803888 NPI number — WHITE ROCK RADIOLOGY ASSOCIATES, L.L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE ROCK RADIOLOGY ASSOCIATES, L.L.P.
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:
1891803888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 180065
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75218-0065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-216-4411
Provider Business Mailing Address Fax Number:
972-216-7346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10935 ESTATE LN
Provider Second Line Business Practice Location Address:
#S126
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75238-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-216-4411
Provider Business Practice Location Address Fax Number:
972-216-7346
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEONE
Authorized Official First Name:
RANDOLPH
Authorized Official Middle Name:
TARBET
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
972-216-4411

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 083574601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: K83D . This is a "BC BS TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CS3814 . This is a "PALMETTO RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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