Provider Demographics
NPI:1578629994
Name:METISCAN CC INC
Entity Type:Organization
Organization Name:METISCAN CC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:F
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-368-9966
Mailing Address - Street 1:PO BOX 601449
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75360-1449
Mailing Address - Country:US
Mailing Address - Phone:214-368-9966
Mailing Address - Fax:214-368-9977
Practice Address - Street 1:401 N SHORELINE BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2527
Practice Address - Country:US
Practice Address - Phone:361-884-1674
Practice Address - Fax:361-884-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTX222Medicare PIN