Provider Demographics
NPI:1508978578
Name:DIAGNOSTIC ACQUISITION, LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC ACQUISITION, LLC
Other - Org Name:DIAGNOSTIC MANAGEMENT GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-432-8058
Mailing Address - Street 1:PO BOX 2757
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-2757
Mailing Address - Country:US
Mailing Address - Phone:325-692-6988
Mailing Address - Fax:325-692-6483
Practice Address - Street 1:4800 S TREADAWAY BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7814
Practice Address - Country:US
Practice Address - Phone:325-692-6988
Practice Address - Fax:325-692-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1902561Medicaid
TX1902561Medicaid