1407146384 NPI number — RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA

Table of content: (NPI 1407146384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407146384 NPI number — RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY ASSOCIATES OF NORTH TEXAS, 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:
RADIOLOGY ASSOCIATES OF TARRANT COUNTY PA
Provider Other Organization Name Type Code:
4
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:
1407146384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
816 W CANNON ST
Provider Second Line Business Mailing Address:
CREDENTIALING 1407146384
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-3146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-321-0387
Provider Business Mailing Address Fax Number:
469-522-6889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
816 W CANNON ST
Provider Second Line Business Practice Location Address:
CREDENTIALING 1407146384
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-3146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-321-0387
Provider Business Practice Location Address Fax Number:
469-522-6889
Provider Enumeration Date:
04/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PHELPS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-321-0312

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; 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" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 285250105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121715005 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 285250104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861782740 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 121715008 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121715004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1407146387 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 121715009 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com