Provider Demographics
NPI:1790233294
Name:PRIME DIAGNOSTIC IMAGING OF FORT WORTH, LLC
Entity Type:Organization
Organization Name:PRIME DIAGNOSTIC IMAGING OF FORT WORTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-341-8770
Mailing Address - Street 1:PO BOX 821868
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75382-1868
Mailing Address - Country:US
Mailing Address - Phone:214-341-8770
Mailing Address - Fax:214-341-1603
Practice Address - Street 1:6491 SOUTHWEST BLVD.
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:214-341-8770
Practice Address - Fax:214-341-1603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)