Provider Demographics
NPI:1881881308
Name:PRESTIGE IMAGING, LLC
Entity type:Organization
Organization Name:PRESTIGE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-558-1940
Mailing Address - Street 1:6301 ABRAMS RD
Mailing Address - Street 2:SUITE 131B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7818
Mailing Address - Country:US
Mailing Address - Phone:469-916-8894
Mailing Address - Fax:469-916-8897
Practice Address - Street 1:4410 N MIDKIFF RD
Practice Address - Street 2:SUITE C-8
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4246
Practice Address - Country:US
Practice Address - Phone:432-689-8770
Practice Address - Fax:432-689-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)