Basic Information
Provider Information | |||||||||
NPI: | 1659628659 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HEALTH IMAGING PARTNERS LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ENVISION IMAGING OF LAS COLINAS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8610 EXPLORER DR | ||||||||
Address2: | SUITE 300 | ||||||||
City: | COLORADO SPRINGS | ||||||||
State: | CO | ||||||||
PostalCode: | 809201058 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7199554332 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 925 W ROYAL LANE | ||||||||
Address2: | SUITE 100 | ||||||||
City: | IRVING | ||||||||
State: | TX | ||||||||
PostalCode: | 75039 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2144836200 | ||||||||
FaxNumber: | 2144836201 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/08/2012 | ||||||||
LastUpdateDate: | 01/21/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BENSON | ||||||||
AuthorizedOfficialFirstName: | ANDREW | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF REVENUE OFFICER | ||||||||
AuthorizedOfficialTelephone: | 7199554332 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 293D00000X |   |   | N |   | Laboratories | Physiological Laboratory |   | 2085R0202X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.