Basic Information
| Provider Information | |||||||||
| NPI: | 1659698587 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREFERRED IMAGING OF DENTON, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 674195 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752674195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724791115 | ||||||||
| FaxNumber: | 9724791118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1614 SCRIPTURE ST | ||||||||
| Address2: | STE 2 | ||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762013837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403876159 | ||||||||
| FaxNumber: | 9403823875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2010 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | KASSA | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9045150362 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | P00914666 | 01 | RAILROAD MEDICARE | OTHER | 0761DC | 01 | TX | BCBS TX | OTHER | 220125301 | 05 | TX | MEDICAID |