Provider Demographics
NPI:1891491569
Name:DIAGNOSTIC CENTER OF TEXAS
Entity Type:Organization
Organization Name:DIAGNOSTIC CENTER OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:ARNEZ
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-888-8165
Mailing Address - Street 1:11821 BASILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8871
Mailing Address - Country:US
Mailing Address - Phone:682-888-6592
Mailing Address - Fax:
Practice Address - Street 1:891 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2482
Practice Address - Country:US
Practice Address - Phone:817-888-8165
Practice Address - Fax:817-888-8165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service