Provider Demographics
NPI:1508863143
Name:NORTH DALLAS MEDICAL IMAGING
Entity Type:Organization
Organization Name:NORTH DALLAS MEDICAL IMAGING
Other - Org Name:ADVANCED MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-458-6888
Mailing Address - Street 1:PO BOX 601449
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75360-1449
Mailing Address - Country:US
Mailing Address - Phone:214-368-9966
Mailing Address - Fax:214-368-9977
Practice Address - Street 1:12800 PRESTON RD
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1367
Practice Address - Country:US
Practice Address - Phone:972-458-6888
Practice Address - Fax:972-458-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0283DCOtherBCBS OF TEXAS
TXFTX124Medicare ID - Type Unspecified