1659365070 NPI number — TOUCHSTONE IMAGING OF MESQUITE, LP

Table of content: (NPI 1659365070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659365070 NPI number — TOUCHSTONE IMAGING OF MESQUITE, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOUCHSTONE IMAGING OF MESQUITE, LP
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:
1659365070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 116662
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-6662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-216-4411
Provider Business Mailing Address Fax Number:
972-216-7346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3304 COMMUNICATIONS PKWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-8115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-378-6858
Provider Business Practice Location Address Fax Number:
972-378-9088
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RICE
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CHIEF MANAGER
Authorized Official Telephone Number:
615-661-9200

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0305DC . This is a "BLUECROSSBLUESHIELD OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00150077 . This is a "PALMETTO GBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 75093 . This is a "CHAMPUS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153466102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 153466103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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