Provider Demographics
NPI:1023717923
Name:AMBULANT IMAGING LLC
Entity type:Organization
Organization Name:AMBULANT IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:214-989-5583
Mailing Address - Street 1:1338 JUNIPER LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2838
Mailing Address - Country:US
Mailing Address - Phone:121-498-9558
Mailing Address - Fax:
Practice Address - Street 1:1338 JUNIPER LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2838
Practice Address - Country:US
Practice Address - Phone:214-989-5583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile