Provider Demographics
NPI:1891803888
Name:WHITE ROCK RADIOLOGY ASSOCIATES, L.L.P.
Entity type:Organization
Organization Name:WHITE ROCK RADIOLOGY ASSOCIATES, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:TARBET
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-216-4411
Mailing Address - Street 1:PO BOX 180065
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-0065
Mailing Address - Country:US
Mailing Address - Phone:972-216-4411
Mailing Address - Fax:972-216-7346
Practice Address - Street 1:10935 ESTATE LN
Practice Address - Street 2:#S126
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2316
Practice Address - Country:US
Practice Address - Phone:972-216-4411
Practice Address - Fax:972-216-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083574601Medicaid
TXK83DOtherBC BS TEXAS
TXCS3814OtherPALMETTO RAILROAD MEDICARE
TX083574601Medicaid