Provider Demographics
NPI:1477061794
Name:BLUE STONE FRISCO JV, LLP DBA BLUE STAR IMAGING AT THE STAR
Entity Type:Organization
Organization Name:BLUE STONE FRISCO JV, LLP DBA BLUE STAR IMAGING AT THE STAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-647-6154
Mailing Address - Street 1:1 COWBOYS WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1995
Mailing Address - Country:US
Mailing Address - Phone:972-497-4100
Mailing Address - Fax:972-497-4104
Practice Address - Street 1:3800 GAYLORD PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-497-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology