| NPI | 1710030366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE RUSSELL Credentialing COO Rdinator 806-354-5495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: TX R05258) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R05258) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |