Provider Demographics
NPI:1114074614
Name:STONEBRIAR IMAGING LP
Entity Type:Organization
Organization Name:STONEBRIAR IMAGING LP
Other - Org Name:STONEBRIAR MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:214-618-4674
Mailing Address - Street 1:3550 PARKWOOD BLVD
Mailing Address - Street 2:C302
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1903
Mailing Address - Country:US
Mailing Address - Phone:214-618-4674
Mailing Address - Fax:214-618-4681
Practice Address - Street 1:3550 PARKWOOD BLVD
Practice Address - Street 2:SUITE C 302
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1903
Practice Address - Country:US
Practice Address - Phone:214-618-4674
Practice Address - Fax:214-618-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR28955261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174224901Medicaid
TX174224901Medicaid