Provider Demographics
NPI:1851342125
Name:SUSAN NICHOLS HOSTETTER M D P A
Entity Type:Organization
Organization Name:SUSAN NICHOLS HOSTETTER M D P A
Other - Org Name:DENTON RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-898-7000
Mailing Address - Street 1:3000 N I-35
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-5119
Mailing Address - Country:US
Mailing Address - Phone:940-898-7000
Mailing Address - Fax:
Practice Address - Street 1:3000 N I-35
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5119
Practice Address - Country:US
Practice Address - Phone:940-898-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084719601Medicaid
TX00R25RMedicare PIN