1871676643 NPI number — AMERICAN DYNAMIC IMAGING LTD

Table of content: (NPI 1871676643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871676643 NPI number — AMERICAN DYNAMIC IMAGING LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN DYNAMIC 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:
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:
1871676643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
797 LONESOME DOVE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76054-6018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-577-7500
Provider Business Mailing Address Fax Number:
817-577-7501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9627 HUEBNER RD.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-690-3400
Provider Business Practice Location Address Fax Number:
210-690-3407
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALTERS
Authorized Official First Name:
GAY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-577-7500

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0543DC . This is a "BCBS PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00234833 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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