Provider Demographics
NPI:1306039078
Name:ENVISION DIAGNOSTIC ULTRASOUND IMAGING
Entity Type:Organization
Organization Name:ENVISION DIAGNOSTIC ULTRASOUND IMAGING
Other - Org Name:ENVISION DIAGNOSTIC ULTRASOUND IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-951-5151
Mailing Address - Street 1:PO BOX 542767
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-2767
Mailing Address - Country:US
Mailing Address - Phone:214-951-5151
Mailing Address - Fax:
Practice Address - Street 1:3125 S CARRIER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3735
Practice Address - Country:US
Practice Address - Phone:972-262-9000
Practice Address - Fax:972-262-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTUV11Medicare UPIN