Provider Demographics
NPI:1164966651
Name:PRIME DIAGNOSTIC IMAGING OF IRVING, LLC
Entity Type:Organization
Organization Name:PRIME DIAGNOSTIC IMAGING OF IRVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-341-8770
Mailing Address - Street 1:PO BOX 821868
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75382-1868
Mailing Address - Country:US
Mailing Address - Phone:214-341-8770
Mailing Address - Fax:214-341-1603
Practice Address - Street 1:2210 PADDOCK WAY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050
Practice Address - Country:US
Practice Address - Phone:214-341-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR39509261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology