Provider Demographics
NPI:1992880827
Name:PREFERRED IMAGING AT THE MEDICAL CENTER LTD
Entity type:Organization
Organization Name:PREFERRED IMAGING AT THE MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NETWORK DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:CLERISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-215-7410
Mailing Address - Street 1:PO BOX 674056
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4056
Mailing Address - Country:US
Mailing Address - Phone:972-479-1115
Mailing Address - Fax:972-479-1118
Practice Address - Street 1:5920 FOREST PARK RD.
Practice Address - Street 2:STE 560
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6400
Practice Address - Country:US
Practice Address - Phone:214-350-0708
Practice Address - Fax:214-764-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTXU46OtherBCBS TX
TXP00237806OtherRAILROAD MEDICARE
TX172124301Medicaid
FTXU46Medicare PIN