Provider Demographics
NPI:1770557415
Name:OPEN DIAGNOSTIC IMAGING
Entity type:Organization
Organization Name:OPEN DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-826-8822
Mailing Address - Street 1:5025 W PARK BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2584
Mailing Address - Country:US
Mailing Address - Phone:972-596-1934
Mailing Address - Fax:972-596-4934
Practice Address - Street 1:8119 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6306
Practice Address - Country:US
Practice Address - Phone:214-346-0634
Practice Address - Fax:214-368-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
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
TXFTX008Medicare ID - Type Unspecified