Provider Demographics
NPI:1801897905
Name:IMAGING & MEDICAL DIAGNOSTIC SPECIALISTS, P.A.
Entity type:Organization
Organization Name:IMAGING & MEDICAL DIAGNOSTIC SPECIALISTS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-306-0215
Mailing Address - Street 1:PO BOX 152409
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-8409
Mailing Address - Country:US
Mailing Address - Phone:817-543-2412
Mailing Address - Fax:817-543-2663
Practice Address - Street 1:3100 MATLOCK RD STE 105
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2900
Practice Address - Country:US
Practice Address - Phone:817-543-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145359901Medicaid
TX145359901Medicaid