Provider Demographics
NPI:1578548814
Name:SPECIALIZED IMAGING SERVICES, INC
Entity Type:Organization
Organization Name:SPECIALIZED IMAGING SERVICES, INC
Other - Org Name:DIAGNOSTIC HEALTH SERIVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-242-8500
Mailing Address - Street 1:5055 KELLER SPRINGS RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5997
Mailing Address - Country:US
Mailing Address - Phone:214-242-8500
Mailing Address - Fax:214-242-8600
Practice Address - Street 1:574 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1342
Practice Address - Country:US
Practice Address - Phone:317-834-3880
Practice Address - Fax:317-834-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN142970Medicare PIN