Provider Demographics
NPI:1255386751
Name:RADIOLOGY OF NORTH TEXAS PA
Entity type:Organization
Organization Name:RADIOLOGY OF NORTH TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-359-7788
Mailing Address - Street 1:800 ROCKMEAD DR
Mailing Address - Street 2:S:210
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2112
Mailing Address - Country:US
Mailing Address - Phone:281-359-7788
Mailing Address - Fax:281-359-7888
Practice Address - Street 1:2000 S FM 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3702
Practice Address - Country:US
Practice Address - Phone:281-359-7788
Practice Address - Fax:281-359-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181574801Medicaid
TX181574801Medicaid
TX00W485Medicare PIN