Basic Information
| Provider Information | |||||||||
| NPI: | 1538116173 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEORGETOWN DIAGNOSTIC IMAGING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1528 LEANDER RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786288801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128630782 | ||||||||
| FaxNumber: | 5128632054 | ||||||||
| Practice Location | |||||||||
| Address1: | 1528 LEANDER RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786288801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128630782 | ||||||||
| FaxNumber: | 5128632054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | MEISCHEN | ||||||||
| AuthorizedOfficialFirstName: | DINAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5128630782 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471C3402X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography |
No ID Information.