Basic Information
| Provider Information | |||||||||
| NPI: | 1003909078 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN RADIOLOGY CONSULTANTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 678253 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752678253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007649729 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1405 W JEFFERSON | ||||||||
| Address2: | |||||||||
| City: | WAXAHACHIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751652231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148268822 | ||||||||
| FaxNumber: | 2148269792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | FULMER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2148268822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 156545902 | 05 | TX | MEDICAID | 156545904 | 05 | TX | MEDICAID |