Provider Demographics
NPI:1831201888
Name:KMA RADIOLOGY, PA
Entity type:Organization
Organization Name:KMA RADIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:214-458-7758
Mailing Address - Street 1:5930 ROYAL LANE
Mailing Address - Street 2:#221
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3849
Mailing Address - Country:US
Mailing Address - Phone:214-458-7758
Mailing Address - Fax:214-242-2301
Practice Address - Street 1:5930 ROYAL LANE
Practice Address - Street 2:#221
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3849
Practice Address - Country:US
Practice Address - Phone:214-893-9197
Practice Address - Fax:214-904-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0051MCOtherBC GROUP
TX00652YMedicare ID - Type Unspecified