Provider Demographics
NPI:1891981783
Name:FORT WORTH I ENTERPRISES, LLC
Entity Type:Organization
Organization Name:FORT WORTH I ENTERPRISES, LLC
Other - Org Name:HEALTHY IMAGES OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-832-3654
Mailing Address - Street 1:4150 INTERNATIONAL PLZ
Mailing Address - Street 2:SUITE 624
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4892
Mailing Address - Country:US
Mailing Address - Phone:817-349-4408
Mailing Address - Fax:817-349-4409
Practice Address - Street 1:4150 INTERNATIONAL PLZ
Practice Address - Street 2:SUITE 624
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4892
Practice Address - Country:US
Practice Address - Phone:817-349-4408
Practice Address - Fax:817-349-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier