Provider Demographics
NPI:1659777415
Name:MEDICAL IMAGING OF GRAPEVINE
Entity Type:Organization
Organization Name:MEDICAL IMAGING OF GRAPEVINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-502-8157
Mailing Address - Street 1:2140 E SOUTHLAKE BLVD
Mailing Address - Street 2:STE L-426
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6516
Mailing Address - Country:US
Mailing Address - Phone:866-333-8443
Mailing Address - Fax:866-316-0080
Practice Address - Street 1:3801 WILLIAM D TATE AVE
Practice Address - Street 2:STE 800
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8755
Practice Address - Country:US
Practice Address - Phone:866-333-8443
Practice Address - Fax:866-316-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty