Provider Demographics
NPI:1821378845
Name:LAKE HIGHLAND IMAGING, LLC
Entity Type:Organization
Organization Name:LAKE HIGHLAND IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-368-6909
Mailing Address - Street 1:PO BOX 674282
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4282
Mailing Address - Country:US
Mailing Address - Phone:972-479-1115
Mailing Address - Fax:972-479-1118
Practice Address - Street 1:9440 GARLAND RD
Practice Address - Street 2:SUITE 190
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-5003
Practice Address - Country:US
Practice Address - Phone:214-388-2030
Practice Address - Fax:214-388-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)