Provider Demographics
NPI:1124551759
Name:VIGILANT IMAGING AND PAIN SUITES, PA
Entity Type:Organization
Organization Name:VIGILANT IMAGING AND PAIN SUITES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-969-2784
Mailing Address - Street 1:2220 CANTON ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-5923
Mailing Address - Country:US
Mailing Address - Phone:832-969-2784
Mailing Address - Fax:469-250-4880
Practice Address - Street 1:8865 DAVIS BLVD
Practice Address - Street 2:SUITE 100A
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0322
Practice Address - Country:US
Practice Address - Phone:832-969-2784
Practice Address - Fax:469-250-4880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8869261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology