Provider Demographics
NPI:1710490537
Name:SWDIC IMAGING CENTER PARTNERSHIP, LLP
Entity Type:Organization
Organization Name:SWDIC IMAGING CENTER PARTNERSHIP, LLP
Other - Org Name:SOUTHWEST DIAGNOSTIC IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-345-4141
Mailing Address - Street 1:8440 WALNUT HILL LN STE 520
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3800
Mailing Address - Country:US
Mailing Address - Phone:214-345-4141
Mailing Address - Fax:214-345-2099
Practice Address - Street 1:8230 WALNUT HILL LN STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4407
Practice Address - Country:US
Practice Address - Phone:214-345-6905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR18642261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX470001463OtherRAILROAD MEDICARE
TXMDD0438OtherWORKERS COMP
TX141643001Medicaid
TX0019CCOtherBCBS