Provider Demographics
NPI:1851322473
Name:PRESTIGE IMAGING, LLC
Entity Type:Organization
Organization Name:PRESTIGE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-558-1940
Mailing Address - Street 1:820 E CARTWRIGHT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6000
Mailing Address - Country:US
Mailing Address - Phone:972-288-2077
Mailing Address - Fax:972-329-0311
Practice Address - Street 1:820 E CARTWRIGHT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6000
Practice Address - Country:US
Practice Address - Phone:972-288-2077
Practice Address - Fax:972-329-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR29470261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology