Provider Demographics
NPI:1487939328
Name:FORT WORTH RADIOLOGY, PLLC
Entity type:Organization
Organization Name:FORT WORTH RADIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-885-8505
Mailing Address - Street 1:2603 8TH AVE STE D
Mailing Address - Street 2:SUITE D,
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2603 8TH AVE STE D
Practice Address - Street 2:SUITE D,
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-3000
Practice Address - Country:US
Practice Address - Phone:817-885-8505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty