Provider Demographics
NPI:1508256157
Name:PEDIATRIC IMAGING ASSOCIATES LLC
Entity Type:Organization
Organization Name:PEDIATRIC IMAGING ASSOCIATES LLC
Other - Org Name:CHILDREN'S HEALTH IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-456-7000
Mailing Address - Street 1:PO BOX 674194
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4194
Mailing Address - Country:US
Mailing Address - Phone:469-362-6909
Mailing Address - Fax:
Practice Address - Street 1:7211 PRESTON RD STE 1400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0240
Practice Address - Country:US
Practice Address - Phone:972-248-0077
Practice Address - Fax:972-248-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology