Provider Demographics
NPI:1265439939
Name:CLEARSKY MRI & DIAGNOSTIC IMAGING CENTER OF N. DALLAS
Entity type:Organization
Organization Name:CLEARSKY MRI & DIAGNOSTIC IMAGING CENTER OF N. DALLAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:972-669-3100
Mailing Address - Street 1:PO BOX 742225
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-2225
Mailing Address - Country:US
Mailing Address - Phone:972-669-3100
Mailing Address - Fax:972-669-3101
Practice Address - Street 1:12606 GREENVILLE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1921
Practice Address - Country:US
Practice Address - Phone:972-669-3100
Practice Address - Fax:972-669-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID
TXFTA041Medicare ID - Type UnspecifiedPROVIDER NUMBER