Provider Demographics
NPI:1780998922
Name:MAXUM HEALTH SERVICES CORP.
Entity type:Organization
Organization Name:MAXUM HEALTH SERVICES CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER; TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9492-826-0000
Mailing Address - Street 1:PO BOX 848074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8074
Mailing Address - Country:US
Mailing Address - Phone:817-335-5370
Mailing Address - Fax:
Practice Address - Street 1:1121 8TH AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4102
Practice Address - Country:US
Practice Address - Phone:817-335-5370
Practice Address - Fax:817-877-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology