Basic Information
| Provider Information | |||||||||
| NPI: | 1851582084 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH DALLAS IMAGING PROVIDERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 269092 | ||||||||
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| City: | OKLAHOMA CITY, | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724791115 | ||||||||
| FaxNumber: | 9724791118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1778 N. PLANO RD., STE. 300 | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722340004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 08/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | SAKURADA | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGED CARE CORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 9724791115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471M1202X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Magnetic Resonance Imaging |
No ID Information.