1740274166 NPI number — TOUCHSTONE IMAGING OF MESQUITE, LP

Table of content: (NPI 1740274166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740274166 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:
1740274166
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:
8070 PARK LN
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-346-0260
Provider Business Practice Location Address Fax Number:
214-346-0261
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: 0346DC . This is a "BLUECROSSBLUESHIEL OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 75231 . This is a "CHAMPUS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 170264902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170264901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00188436 . This is a "PALMETTO GBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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