Provider Demographics
NPI:1942317847
Name:CLEARSKY MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:CLEARSKY MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-786-8712
Mailing Address - Street 1:12606 GREENVILLE AVE
Mailing Address - Street 2:110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1921
Mailing Address - Country:US
Mailing Address - Phone:972-669-3100
Mailing Address - Fax:972-669-3101
Practice Address - Street 1:12606 GREENVILLE AVE
Practice Address - Street 2:110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1921
Practice Address - Country:US
Practice Address - Phone:972-669-3100
Practice Address - Fax:972-669-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR29992261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology