Provider Demographics
NPI:1245525799
Name:IMAGIN ETC INC.
Entity type:Organization
Organization Name:IMAGIN ETC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-988-9800
Mailing Address - Street 1:2507 MEDICAL ROW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1070
Mailing Address - Country:US
Mailing Address - Phone:214-688-8717
Mailing Address - Fax:972-988-9807
Practice Address - Street 1:655 S GREAT SOUTHWEST PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1068
Practice Address - Country:US
Practice Address - Phone:214-688-8717
Practice Address - Fax:972-988-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)