Provider Demographics
NPI:1952850810
Name:DIAGNOSTIC IMAGING CENTER AT TEXAS NEUROLOGY
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING CENTER AT TEXAS NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-279-0324
Mailing Address - Street 1:6301 GASTON AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3922
Mailing Address - Country:US
Mailing Address - Phone:214-826-6700
Mailing Address - Fax:214-827-4343
Practice Address - Street 1:6301 GASTON AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3922
Practice Address - Country:US
Practice Address - Phone:214-826-6700
Practice Address - Fax:214-827-4343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS NEUROLOGY, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)