Provider Demographics
NPI:1043362916
Name:PRESTIGE IMAGING, LLC
Entity Type:Organization
Organization Name:PRESTIGE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:817-558-1940
Mailing Address - Street 1:106 HYDE PARK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4523
Mailing Address - Country:US
Mailing Address - Phone:817-558-1940
Mailing Address - Fax:817-558-1960
Practice Address - Street 1:4780 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4615
Practice Address - Country:US
Practice Address - Phone:972-492-1334
Practice Address - Fax:972-492-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)