Provider Demographics
NPI:1972694099
Name:MEDICAL IMAGING OF DALLAS, LLP
Entity type:Organization
Organization Name:MEDICAL IMAGING OF DALLAS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-906-6276
Mailing Address - Street 1:PO BOX 814129
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75381-4129
Mailing Address - Country:US
Mailing Address - Phone:972-906-6250
Mailing Address - Fax:972-906-0116
Practice Address - Street 1:102 DECKER CT STE 205
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2740
Practice Address - Country:US
Practice Address - Phone:972-906-6250
Practice Address - Fax:972-906-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093792201Medicaid
TX00FM63Medicare ID - Type Unspecified