Provider Demographics
NPI:1376804542
Name:REGIONAL DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:REGIONAL DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-916-8581
Mailing Address - Street 1:PO BOX 743713
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-3713
Mailing Address - Country:US
Mailing Address - Phone:972-916-8581
Mailing Address - Fax:
Practice Address - Street 1:1701 GATEWAY BLVD
Practice Address - Street 2:SUITE 460
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3572
Practice Address - Country:US
Practice Address - Phone:972-916-8581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile