Provider Demographics
NPI:1639893639
Name:MONTICELLO DIAGNOSTIC IMAGING CLEBURNE, LP
Entity Type:Organization
Organization Name:MONTICELLO DIAGNOSTIC IMAGING CLEBURNE, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIR OF REV CYCLE MGMT
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-202-5179
Mailing Address - Street 1:550 BAILEY AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2175
Mailing Address - Country:US
Mailing Address - Phone:817-402-0269
Mailing Address - Fax:
Practice Address - Street 1:105 N RIDGEWAY CT
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4180
Practice Address - Country:US
Practice Address - Phone:682-317-9178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty