Adelaide Diagnostic Center LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

J6228 Issued in TX

Legal business name

ADELAIDE DIAGNOSTIC CENTER LLC

Practice address

2692 W Walnut St
Suite #108
Garland, TX 75042-6474

Phone

(214) 328-3333

Fax

(214) 328-3330

NPI assigned

Sep 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jackson Jacob

Title

General Manager

Phone

(214) 328-3333

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203379200000",
    "number": "1205933256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1123 WESTMINISTER AVE",
            "city": "MURPHY",
            "state": "TX",
            "postal_code": "750944158",
            "telephone_number": "214-328-3333",
            "fax_number": "214-328-3330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2692 W WALNUT ST",
            "address_2": "SUITE #108",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750426474",
            "telephone_number": "214-328-3333",
            "fax_number": "214-328-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADELAIDE DIAGNOSTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-02-19",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "214-328-3333",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "J6228",
            "primary": true
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "0623DC",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.