Provider Demographics
NPI:1558431619
Name:FW IMAGING
Entity Type:Organization
Organization Name:FW IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-207-9600
Mailing Address - Street 1:4400 OAK PARK LANE
Mailing Address - Street 2:STE 101
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-207-9600
Mailing Address - Fax:817-207-9692
Practice Address - Street 1:4400 OAK PARK LANE
Practice Address - Street 2:STE 101
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-207-9600
Practice Address - Fax:817-207-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00289429OtherMEDICARE RAILROAD
TXP00289429OtherMEDICARE RAILROAD