Provider Demographics
NPI:1497284970
Name:ENVISION DIAGNOSTICS MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ENVISION DIAGNOSTICS MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-882-5353
Mailing Address - Street 1:12835 PRESTON RD STE 405
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1294
Mailing Address - Country:US
Mailing Address - Phone:214-803-6760
Mailing Address - Fax:972-392-4478
Practice Address - Street 1:12835 PRESTON RD STE 405
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1294
Practice Address - Country:US
Practice Address - Phone:214-803-6760
Practice Address - Fax:972-392-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty