Provider Demographics
NPI:1619512993
Name:EXCEPTIONAL GARLAND MEDICAL PLAZA IMAGING LLC
Entity Type:Organization
Organization Name:EXCEPTIONAL GARLAND MEDICAL PLAZA IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAHBOUBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-341-7800
Mailing Address - Street 1:1100 S AKARD ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-1003
Mailing Address - Country:US
Mailing Address - Phone:469-341-7800
Mailing Address - Fax:
Practice Address - Street 1:4555 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5143
Practice Address - Country:US
Practice Address - Phone:469-341-7800
Practice Address - Fax:469-341-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty