Basic Information
| Provider Information | |||||||||
| NPI: | 1962718064 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH TEXAS PEM PARTNERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 678027 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752678027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724791115 | ||||||||
| FaxNumber: | 9723468015 | ||||||||
| Practice Location | |||||||||
| Address1: | 5072 W PLANO PKWY | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750934476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727333531 | ||||||||
| FaxNumber: | 9723466564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2010 | ||||||||
| LastUpdateDate: | 10/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | WEBB | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4693626909 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | L06340 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | L06340 | 01 | TX | RADIOACTIVE MATERIAL LICENSE | OTHER |