1417982174 NPI number — DX IMAGING, LTD

Table of content: (NPI 1417982174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417982174 NPI number — DX IMAGING, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DX IMAGING, LTD
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:
1417982174
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:
PO BOX 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75461-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-785-6029
Provider Business Mailing Address Fax Number:
903-785-5421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 N JEFFERSON AVE
Provider Second Line Business Practice Location Address:
3003 JOE RAMSEY BLVD GREENVILLE TX 75401
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75455-2334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-575-0325
Provider Business Practice Location Address Fax Number:
903-577-9615
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARKHILL
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
903-785-6029

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: 00667N . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0184DC . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".