Provider Demographics
NPI:1528457769
Name:DIAGNOSTIC IMAGE PLUS INC.
Entity type:Organization
Organization Name:DIAGNOSTIC IMAGE PLUS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VARGHESE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-613-0555
Mailing Address - Street 1:3022 MOTLEY DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3440
Mailing Address - Country:US
Mailing Address - Phone:972-613-0555
Mailing Address - Fax:972-613-0546
Practice Address - Street 1:8210 WALNUT HILL LN STE 304
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4419
Practice Address - Country:US
Practice Address - Phone:972-685-2727
Practice Address - Fax:972-685-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1783243-01Medicaid
TXR29810OtherTEXAS RADIATION LICENCE
TXP00295618OtherRAIL ROAD MEDICARE
TXR29810OtherTEXAS RADIATION LICENCE