1467766550 NPI number — USMD DIAGNOSTIC SERVICES, LLC

Table of content: (NPI 1467766550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467766550 NPI number — USMD DIAGNOSTIC SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USMD DIAGNOSTIC SERVICES, 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:
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:
1467766550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 678168
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:
75267-8168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-847-0712
Provider Business Mailing Address Fax Number:
817-514-5246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 AIRPORT FREEWAY
Provider Second Line Business Practice Location Address:
SUITE 132
Provider Business Practice Location Address City Name:
HURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76054-3252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-514-5200
Provider Business Practice Location Address Fax Number:
817-514-5210
Provider Enumeration Date:
07/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BUKOSKY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT PPM
Authorized Official Telephone Number:
817-514-5290

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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