Provider Demographics
NPI:1073672192
Name:RADIOLOGY ASSOCIATES OF NORTH TEXAS PA
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF NORTH TEXAS PA
Other - Org Name:PET/CT OF LAS COLINAS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUERALT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-321-0312
Mailing Address - Street 1:816 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3146
Mailing Address - Country:US
Mailing Address - Phone:817-321-0387
Mailing Address - Fax:469-522-6889
Practice Address - Street 1:7415 LAS COLINAS BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7568
Practice Address - Country:US
Practice Address - Phone:817-321-0312
Practice Address - Fax:817-317-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2085B0100X
2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB120692Medicare PIN