Provider Demographics
NPI:1134345879
Name:TARRANT DIAGNOSTIC IMAGING, LLC
Entity type:Organization
Organization Name:TARRANT DIAGNOSTIC IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-335-5370
Mailing Address - Street 1:1121 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4102
Mailing Address - Country:US
Mailing Address - Phone:817-335-5370
Mailing Address - Fax:817-335-5318
Practice Address - Street 1:1121 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4102
Practice Address - Country:US
Practice Address - Phone:817-335-5370
Practice Address - Fax:817-335-5318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL05655261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTN012Medicare ID - Type UnspecifiedDIAGNOSTIC RAD CLINIC
TXFTNX05Medicare ID - Type UnspecifiedDIAGNOSTIC RAD CLINIC