Provider Demographics
NPI:1386880748
Name:F S DIAGNOSTICS P A
Entity type:Organization
Organization Name:F S DIAGNOSTICS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BREAZEALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-988-9512
Mailing Address - Street 1:7301 STATE HIGHWAY 161
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2816
Mailing Address - Country:US
Mailing Address - Phone:972-387-5800
Mailing Address - Fax:972-387-5809
Practice Address - Street 1:7737 SOUTHWEST FWY
Practice Address - Street 2:SUITE 780
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-988-9512
Practice Address - Fax:713-988-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082754501Medicaid
TX00G92GOtherBLUE CROSS
TX082754501Medicaid