Provider Demographics
NPI:1942376611
Name:TEXARKANA GALLERIA OAKS DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:TEXARKANA GALLERIA OAKS DIAGNOSTIC CENTER LLC
Other - Org Name:GALLERIA OAKS DISGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VUORENNE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:903-792-2990
Mailing Address - Street 1:2014 GALLERIA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4620
Mailing Address - Country:US
Mailing Address - Phone:903-792-2990
Mailing Address - Fax:903-792-2995
Practice Address - Street 1:208 N 26TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4337
Practice Address - Country:US
Practice Address - Phone:870-246-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F354Medicare ID - Type Unspecified
ARDE0037Medicare ID - Type UnspecifiedRAILROAD