Provider Demographics
NPI:1407258106
Name:DRS DIAGNOSTIC IMAGING
Entity Type:Organization
Organization Name:DRS DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RANDAL
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-277-0177
Mailing Address - Street 1:1935 BROWN BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-4605
Mailing Address - Country:US
Mailing Address - Phone:817-277-0177
Mailing Address - Fax:817-275-3474
Practice Address - Street 1:1935 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-4605
Practice Address - Country:US
Practice Address - Phone:817-277-0177
Practice Address - Fax:817-275-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14001261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service