Provider Demographics
NPI:1962648063
Name:NUCARDIO IMAGING, INC
Entity Type:Organization
Organization Name:NUCARDIO IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / NUCLEAR MEDICINE TECHNO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HOMER
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ARRT
Authorized Official - Phone:817-688-8849
Mailing Address - Street 1:6717 SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-4545
Mailing Address - Country:US
Mailing Address - Phone:817-688-8849
Mailing Address - Fax:817-556-2204
Practice Address - Street 1:800 8TH AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2601
Practice Address - Country:US
Practice Address - Phone:817-688-8849
Practice Address - Fax:817-688-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-20
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13410261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center