Provider Demographics
NPI:1891733275
Name:PATIENTS COMPREHENSIVE DIAGNOSTIC & RADIATION CENTER, INC
Entity type:Organization
Organization Name:PATIENTS COMPREHENSIVE DIAGNOSTIC & RADIATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'ANDREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-579-0061
Mailing Address - Street 1:PO BOX 7907
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-7907
Mailing Address - Country:US
Mailing Address - Phone:281-579-0061
Mailing Address - Fax:281-579-0093
Practice Address - Street 1:4352 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4602
Practice Address - Country:US
Practice Address - Phone:281-579-0061
Practice Address - Fax:281-579-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0210DCOtherBLUE CROSS
TX149572301Medicaid
TX00624RMedicare ID - Type UnspecifiedMEDICARE