Provider Demographics
NPI:1376557710
Name:CLINICAL RADIOLOGY & IMAGING ASSOCIATES
Entity Type:Organization
Organization Name:CLINICAL RADIOLOGY & IMAGING ASSOCIATES
Other - Org Name:V.A. HOSPITAL OF DALLAS.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VEENA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAULAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-321-2800
Mailing Address - Street 1:10216 GARLAND RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2921
Mailing Address - Country:US
Mailing Address - Phone:214-321-2800
Mailing Address - Fax:214-321-2872
Practice Address - Street 1:10216 GARLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2921
Practice Address - Country:US
Practice Address - Phone:214-321-2800
Practice Address - Fax:214-321-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE08722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000R42P2Medicaid
TX00R42PMedicare ID - Type Unspecified
TXP000R42P2Medicaid