Provider Demographics
NPI:1093752891
Name:IMPEL MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:IMPEL MANAGEMENT SERVICES, LLC
Other - Org Name:SPECIALIZED DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIAGNOSTIC OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LANGELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-514-4009
Mailing Address - Street 1:900 AIRPORT FWY
Mailing Address - Street 2:SUITE 158
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3250
Mailing Address - Country:US
Mailing Address - Phone:817-514-4006
Mailing Address - Fax:817-514-7821
Practice Address - Street 1:900 AIRPORT FWY
Practice Address - Street 2:SUITE 158
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3250
Practice Address - Country:US
Practice Address - Phone:817-514-4006
Practice Address - Fax:817-514-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTA072Medicare ID - Type Unspecified
TXY00617Medicare UPIN