Provider Demographics
NPI:1811932577
Name:TENET GULF COAST IMAGING
Entity type:Organization
Organization Name:TENET GULF COAST IMAGING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VSVP OF OUTPATIENT SERVICES, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BURTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2153
Mailing Address - Street 1:PO BOX 676764
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-6764
Mailing Address - Country:US
Mailing Address - Phone:228-396-1601
Mailing Address - Fax:228-392-9620
Practice Address - Street 1:975A CEDAR LAKE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2128
Practice Address - Country:US
Practice Address - Phone:228-395-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
470-00-040Medicare PIN