1114971637 NPI number — QUALITY PORTABLE X-RAY, LLC

Table of content: DR. NICHOLAS ANDREW SHEETS MD (NPI 1659011880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114971637 NPI number — QUALITY PORTABLE X-RAY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY PORTABLE X-RAY, 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:
6
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:
1114971637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9850 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
#268
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75231-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-360-7707
Provider Business Mailing Address Fax Number:
214-360-7701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9850 N CENTRAL EXPY
Provider Second Line Business Practice Location Address:
#268
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-360-7707
Provider Business Practice Location Address Fax Number:
214-360-7701
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBSON
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
214-360-7707

Provider Taxonomy Codes

  • Taxonomy code: 247100000X , with the licence number:  22853 , 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: 22853 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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