Provider Demographics
NPI:1770680035
Name:CARDIOVASCULAR MRI OF DALLAS INC
Entity Type:Organization
Organization Name:CARDIOVASCULAR MRI OF DALLAS INC
Other - Org Name:MRI CENTRAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:DORNELL
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-356-4304
Mailing Address - Street 1:11 COLLINWAY PLACE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:214-473-9999
Mailing Address - Fax:214-473-6669
Practice Address - Street 1:5865 KINCAID ROAD
Practice Address - Street 2:E-8
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:214-773-9999
Practice Address - Fax:214-473-6669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T80KOtherBCBS
TX109524202Medicaid
TXFTX013Medicare PIN
TX00T80KOtherBCBS
FTX013Medicare PIN