Ethel Shade Dba Sure Shot X-Ray Mobile X-Ray Services

Primary specialty

Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X

License

R31722 Issued in TX

Legal business name

ETHEL SHADE DBA SURE SHOT X-RAY MOBILE X-RAY SERVICES

Practice address

7310 S Westmoreland Rd Ste 11
Dallas, TX 75237-3015

Phone

(972) 822-9292

Fax

(972) 298-1137

NPI assigned

Jan 7, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Ethel Shade, RT

Title

Owner

Phone

(972) 822-9292

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229299200000",
    "number": "1497930630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7310 S WESTMORELAND RD STE 11",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752373015",
            "telephone_number": "972-822-9292",
            "fax_number": "972-298-1137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7310 S WESTMORELAND RD STE 11",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752373015",
            "telephone_number": "972-822-9292",
            "fax_number": "972-298-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHEL SHADE DBA SURE SHOT X-RAY MOBILE X-RAY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-07",
        "last_updated": "2008-12-15",
        "status": "A",
        "authorized_official_last_name": "SHADE",
        "authorized_official_first_name": "ETHEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-822-9292",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RT"
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": "TX",
            "license": "R31722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RADIOLOGY",
            "identifier": "R31722",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eternal Life Services LLC
• Maranda Brooke Etheredge, AGACNP-BC
• Britney Jo Etheridge-Cox, MS, RN, CPNP
• Caroline Elisabeth Etheridge, LPC ASSOCIATE
• Kristina Marie Etheridge, NP
• Cecilia Grace Ethun

• Mobile Radiology Clinic/Center in Dallas, TX
• Providers in Dallas, TX by specialty
• Mobile Radiology Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.