Provider Demographics
NPI:1871676643
Name:AMERICAN DYNAMIC IMAGING LTD
Entity Type:Organization
Organization Name:AMERICAN DYNAMIC IMAGING LTD
Other - Org Name:PHYSICIANS STAND UP MRI LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GAY
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-577-7500
Mailing Address - Street 1:797 LONESOME DOVE TRL
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-6018
Mailing Address - Country:US
Mailing Address - Phone:817-577-7500
Mailing Address - Fax:817-577-7501
Practice Address - Street 1:9627 HUEBNER RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1662
Practice Address - Country:US
Practice Address - Phone:210-690-3400
Practice Address - Fax:210-690-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM1200X
261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0543DCOtherBCBS PIN
TXP00234833OtherRAILROAD MEDICARE PIN
TXFTX313Medicare PIN