Provider Demographics
NPI:1407146384
Name:RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA
Other - Org Name:RADIOLOGY ASSOCIATES OF TARRANT COUNTY PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-321-0312
Mailing Address - Street 1:816 W CANNON ST
Mailing Address - Street 2:CREDENTIALING 1407146384
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3146
Mailing Address - Country:US
Mailing Address - Phone:817-321-0387
Mailing Address - Fax:469-522-6889
Practice Address - Street 1:816 W CANNON ST
Practice Address - Street 2:CREDENTIALING 1407146384
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3146
Practice Address - Country:US
Practice Address - Phone:817-321-0387
Practice Address - Fax:469-522-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285250105Medicaid
TX121715005Medicaid
TX285250104Medicaid
TX1861782740OtherNPI
TX121715008Medicaid
TX121715004Medicaid
TX1407146387OtherNPI
TX121715009Medicaid
TX121715008Medicaid
TXTXB120694Medicare PIN
TX285250105Medicaid