Provider Demographics
NPI:1467793075
Name:BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE
Entity Type:Organization
Organization Name:BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE
Other - Org Name:BAYLOR DIAGNOSTIC IMAGING CENTER - KELLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-820-7808
Mailing Address - Street 1:601 S MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7029
Mailing Address - Country:US
Mailing Address - Phone:817-482-2000
Mailing Address - Fax:
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7029
Practice Address - Country:US
Practice Address - Phone:817-482-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR01024261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology