Provider Demographics
NPI:1063768315
Name:DIAGNOSTIC EVALUATION CENTERS OF AMERICA
Entity type:Organization
Organization Name:DIAGNOSTIC EVALUATION CENTERS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLINTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-693-7367
Mailing Address - Street 1:2850 SHORELINE TRL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5513
Mailing Address - Country:US
Mailing Address - Phone:469-273-3395
Mailing Address - Fax:469-273-3396
Practice Address - Street 1:3334 N TOWN EAST BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3858
Practice Address - Country:US
Practice Address - Phone:214-693-7367
Practice Address - Fax:469-273-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service