Provider Demographics
NPI:1174865539
Name:GLENNHOLLOW MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:GLENNHOLLOW MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:214-793-7309
Mailing Address - Street 1:3060 COMMUNICATIONS PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8449
Mailing Address - Country:US
Mailing Address - Phone:972-312-9944
Mailing Address - Fax:972-312-9962
Practice Address - Street 1:3060 COMMUNICATIONS PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8449
Practice Address - Country:US
Practice Address - Phone:972-312-9944
Practice Address - Fax:972-312-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology