Provider Demographics
NPI:1366630196
Name:PROSCAN MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:PROSCAN MEDICAL IMAGING LLC
Other - Org Name:ECLIPSE MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:MR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-992-4866
Mailing Address - Street 1:6805 NE LOOP 820
Mailing Address - Street 2:SUITE 407
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6687
Mailing Address - Country:US
Mailing Address - Phone:817-992-4866
Mailing Address - Fax:
Practice Address - Street 1:6805 NE LOOP 820
Practice Address - Street 2:SUITE 407
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6687
Practice Address - Country:US
Practice Address - Phone:817-992-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)