Provider Demographics
NPI:1982042305
Name:BTDI JV LLP
Entity Type:Organization
Organization Name:BTDI JV LLP
Other - Org Name:BAYLOR DIAGNOSTIC IMAGING CENTER AT JUNIUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-689-1691
Mailing Address - Street 1:PO BOX 746003
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 JUNIUS ST
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:214-820-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BTDI JV LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-07
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory