Provider Demographics
NPI:1003921644
Name:NORTH TEXAS IMAGING HAMPTON CENTER II LTD
Entity Type:Organization
Organization Name:NORTH TEXAS IMAGING HAMPTON CENTER II LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-941-8908
Mailing Address - Street 1:904 N EWING AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1163
Mailing Address - Country:US
Mailing Address - Phone:214-941-8908
Mailing Address - Fax:214-941-8903
Practice Address - Street 1:2301 S HAMPTON RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1653
Practice Address - Country:US
Practice Address - Phone:214-333-3600
Practice Address - Fax:214-333-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163073301Medicaid
TX163073301Medicaid