Provider Demographics
NPI:1104353580
Name:RADIANT MEDICAL VENTURES
Entity type:Organization
Organization Name:RADIANT MEDICAL VENTURES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-820-8989
Mailing Address - Street 1:PO BOX 4897
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6957 W PLANO PKWY
Practice Address - Street 2:STE 1300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1620
Practice Address - Country:US
Practice Address - Phone:972-820-1400
Practice Address - Fax:972-820-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ64132085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty