Provider Demographics
NPI:1386864007
Name:ECLIPSE MEDICAL IMAGING
Entity Type:Organization
Organization Name:ECLIPSE MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-891-6744
Mailing Address - Street 1:6805 NE LOOP 820
Mailing Address - Street 2:407
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6687
Mailing Address - Country:US
Mailing Address - Phone:817-581-4354
Mailing Address - Fax:817-581-4364
Practice Address - Street 1:6805 NE LOOP 820
Practice Address - Street 2:407
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6687
Practice Address - Country:US
Practice Address - Phone:817-581-4354
Practice Address - Fax:817-581-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology