Provider Demographics
NPI:1336159177
Name:PRESGAR IMAGING OF AMARILLO, LP
Entity Type:Organization
Organization Name:PRESGAR IMAGING OF AMARILLO, LP
Other - Org Name:TEXAS DIAGNOSTIC IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:C
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-358-1010
Mailing Address - Street 1:1000 S COULTER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1781
Mailing Address - Country:US
Mailing Address - Phone:806-358-1010
Mailing Address - Fax:806-359-5457
Practice Address - Street 1:1000 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1781
Practice Address - Country:US
Practice Address - Phone:806-358-1010
Practice Address - Fax:806-359-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T11UOtherBCBS
TX00T11UOtherBCBS