Provider Demographics
NPI:1841335429
Name:METROSTAT DIAGNOSTIC SERVICES INC
Entity type:Organization
Organization Name:METROSTAT DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT
Authorized Official - Phone:972-205-1144
Mailing Address - Street 1:325 GOLD ST
Mailing Address - Street 2:#100
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6658
Mailing Address - Country:US
Mailing Address - Phone:972-205-1144
Mailing Address - Fax:972-205-1115
Practice Address - Street 1:325 GOLD ST
Practice Address - Street 2:#100
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6658
Practice Address - Country:US
Practice Address - Phone:972-205-1144
Practice Address - Fax:972-205-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR29742261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179003202Medicaid
TX179003202Medicaid