Provider Demographics
NPI:1114246311
Name:COLLIN COUNTY IMAGING
Entity Type:Organization
Organization Name:COLLIN COUNTY IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, DMD
Authorized Official - Phone:972-964-1415
Mailing Address - Street 1:5501 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5463
Mailing Address - Country:US
Mailing Address - Phone:972-964-1415
Mailing Address - Fax:972-964-7208
Practice Address - Street 1:5501 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 312
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5463
Practice Address - Country:US
Practice Address - Phone:972-964-1415
Practice Address - Fax:972-964-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182442471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty