Provider Demographics
NPI:1356053375
Name:AVALON IMAGING LLC
Entity type:Organization
Organization Name:AVALON IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:W
Authorized Official - Last Name:REECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-459-9806
Mailing Address - Street 1:4400 STATE HIGHWAY 121 STE 405
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4952
Mailing Address - Country:US
Mailing Address - Phone:972-808-7810
Mailing Address - Fax:972-434-7628
Practice Address - Street 1:811 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4201
Practice Address - Country:US
Practice Address - Phone:432-227-0067
Practice Address - Fax:432-400-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)