Provider Demographics
NPI:1477933299
Name:DIAGNOSTIC GROUP IMAGING PLLC
Entity Type:Organization
Organization Name:DIAGNOSTIC GROUP IMAGING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DATA OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:THIBODAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-730-2022
Mailing Address - Street 1:3406 COLLEGE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4612
Mailing Address - Country:US
Mailing Address - Phone:409-813-1677
Mailing Address - Fax:409-813-1699
Practice Address - Street 1:3480 COLLEGE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701
Practice Address - Country:US
Practice Address - Phone:409-813-1677
Practice Address - Fax:409-813-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-06
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology