1912989054 NPI number — NUMED IMAGING CENTERS, INC

Table of content: (NPI 1912989054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912989054 NPI number — NUMED IMAGING CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUMED IMAGING CENTERS, INC
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:
1912989054
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 1098
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76202-1098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-365-5700
Provider Business Mailing Address Fax Number:
940-365-5077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 S RAGSDALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75766-4936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-589-8164
Provider Business Practice Location Address Fax Number:
903-589-4906
Provider Enumeration Date:
11/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
MARSHA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING COORDINATOR/NETWORK MANAGER
Authorized Official Telephone Number:
940-365-5700

Provider Taxonomy Codes

  • Taxonomy code: 2471N0900X , with the licence number:  L05225 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: L05225 . This is a "RADIOACTIVE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0109DC . This is a "BCBS PROV NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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