Provider Demographics
NPI:1881714467
Name:METROPOLITAN RADIOLOGY, INC.
Entity type:Organization
Organization Name:METROPOLITAN RADIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:CONNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-987-4601
Mailing Address - Street 1:10500 STEPPINGTON DR
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-4561
Mailing Address - Country:US
Mailing Address - Phone:214-987-4601
Mailing Address - Fax:214-987-4039
Practice Address - Street 1:10500 STEPPINGTON DR
Practice Address - Street 2:SUITE 100A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-4561
Practice Address - Country:US
Practice Address - Phone:214-987-4601
Practice Address - Fax:214-987-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDN8753OtherMEDICARE RAILROAD
TX0804361Medicaid
TX0804361Medicaid