Provider Demographics
NPI:1558329680
Name:CENTRAL PARK IMAGING CENTER, LTD.
Entity Type:Organization
Organization Name:CENTRAL PARK IMAGING CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-501-3840
Mailing Address - Street 1:900 W 38TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1127
Mailing Address - Country:US
Mailing Address - Phone:512-501-3840
Mailing Address - Fax:512-501-3841
Practice Address - Street 1:900 W 38TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1127
Practice Address - Country:US
Practice Address - Phone:512-501-3840
Practice Address - Fax:512-501-3841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080970901Medicaid
00669NMedicare PIN