Provider Demographics
NPI:1558483776
Name:BMB ASSOCIATES LLC
Entity Type:Organization
Organization Name:BMB ASSOCIATES LLC
Other - Org Name:NORTH TEXAS DIGITAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MINU
Authorized Official - Middle Name:MAMMEN
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:R, MR, ARRT
Authorized Official - Phone:972-681-4000
Mailing Address - Street 1:2698 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6383
Mailing Address - Country:US
Mailing Address - Phone:972-681-4000
Mailing Address - Fax:972-681-0881
Practice Address - Street 1:2698 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6383
Practice Address - Country:US
Practice Address - Phone:972-681-4000
Practice Address - Fax:972-681-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR31261261Q00000X, 261QR0200X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTXU66Medicare PIN
TXFTUVX9Medicare PIN