1922034602 NPI number — CONSULTANTS IN RADIOLOGY PA

Table of content: (NPI 1922034602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922034602 NPI number — CONSULTANTS IN RADIOLOGY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTANTS IN 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:
1922034602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 208509
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:
75320-8509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-200-7581
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1845 PRECINCT LINE RD
Provider Second Line Business Practice Location Address:
STE. 209
Provider Business Practice Location Address City Name:
HURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76054-3179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-200-7581
Provider Business Practice Location Address Fax Number:
817-336-7637
Provider Enumeration Date:
06/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEBLEU
Authorized Official First Name:
SHARLEE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
480-321-7026

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112624501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00867267 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".