Provider Demographics
NPI:1619922184
Name:E PLUS PET IMAGING XII LP
Entity Type:Organization
Organization Name:E PLUS PET IMAGING XII LP
Other - Org Name:PET IMAGING OF DALLAS-NORTHEAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO OF GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RHYMER
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:615-467-7415
Mailing Address - Street 1:1250 R NORTHWEST HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5851
Mailing Address - Country:US
Mailing Address - Phone:972-279-5172
Mailing Address - Fax:972-279-6948
Practice Address - Street 1:1250 R NORTHWEST HIGHWAY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5851
Practice Address - Country:US
Practice Address - Phone:972-279-5172
Practice Address - Fax:972-279-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0462DCOtherBLUE CROSS/BLUE SHIELD
P00262810OtherRRMEDICARE
FTN028Medicare ID - Type Unspecified