Provider Demographics
NPI:1992968168
Name:PRIME DIAGNOSTIC IMAGING OF ENNIS, LLC
Entity type:Organization
Organization Name:PRIME DIAGNOSTIC IMAGING OF ENNIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-341-8770
Mailing Address - Street 1:1905 W ENNIS AVE # 500
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-3614
Mailing Address - Country:US
Mailing Address - Phone:214-341-8770
Mailing Address - Fax:214-341-1603
Practice Address - Street 1:1905 W ENNIS AVE # 500
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-3614
Practice Address - Country:US
Practice Address - Phone:214-341-8770
Practice Address - Fax:214-341-1603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology