Provider Demographics
NPI:1568468676
Name:CENTER FOR MOLECULAR IMAGING LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:CENTER FOR MOLECULAR IMAGING LIMITED PARTNERSHIP
Other - Org Name:SOUTHWEST DIAGNOSTIC CENTER FOR MOLECULAR IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-345-4141
Mailing Address - Street 1:8196 WALNUT HILL LN
Mailing Address - Street 2:SUITE LL30
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7227
Mailing Address - Country:US
Mailing Address - Phone:214-345-8300
Mailing Address - Fax:214-345-2099
Practice Address - Street 1:8196 WALNUT HILL LN
Practice Address - Street 2:SUITE LL30
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7227
Practice Address - Country:US
Practice Address - Phone:214-345-8300
Practice Address - Fax:214-345-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL05715261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0366DCOtherIDTF BLUE CROSS
TX162648301Medicaid
TX162648301Medicaid