Tidc-Grapevine, Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

R22410 Issued in TX

Legal business name

TIDC-GRAPEVINE, INC

Practice address

5311 William D Tate Ave
Grapevine, TX 76051-7365

Phone

(817) 267-9500

Fax

(817) 545-9400

NPI assigned

Apr 18, 2006

Organization subpart

No

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

Authorized official

Name

Emil Georgio Cerullo

Title

Ceo

Phone

(214) 357-5229

Specialties & licenses 1

Addresses

Other names 1

• Texas Imaging & Diagnostic Center Doing business as

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Leslie John Derdeyn, MD

  • Diagnostic Radiology Physician
  • Dallas, TX
  • NPI 1831198209
  NPD (past)
• Mark Lawrence Kutler, MD

  • Diagnostic Radiology Physician
  • Irving, TX
  • NPI 1225089386
  NPD (past)
• Mark D Meiches, MD

  • Diagnostic Radiology Physician
  • Irving, TX
  • NPI 1093765356
  NPD (past)
• Jaynish Patel, MD

  • Vascular & Interventional Radiology Physician
  • Dallas, TX
  • NPI 1205887577

  Diagnostic Radiology

  NPD (past)
• Richard B Thropp, MD

  • Diagnostic Radiology Physician
  • Dallas, TX
  • NPI 1316998479
  NPD (past)

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190160000000",
    "number": "1689639205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5311 WILLIAM D TATE AVE",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760517365",
            "telephone_number": "817-267-9500",
            "fax_number": "817-545-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5311 WILLIAM D TATE AVE",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760517365",
            "telephone_number": "817-267-9500",
            "fax_number": "817-545-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDC-GRAPEVINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2007-09-19",
        "status": "A",
        "authorized_official_last_name": "CERULLO",
        "authorized_official_first_name": "EMIL",
        "authorized_official_middle_name": "GEORGIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-357-5229"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "R22410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Texas Imaging & Diagnostic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• J. David Thompson, MD
• Kassidy Sheree Thompson, CLD (DV)
• Katie Corbitt Thompson
• John L. Thorne, MD
• Three of a Kind, LLC
• Raymond A Till, P.T.
• Timothy J Rost, M.D. P.a.
• Evelyn Carol Ting, N.P.
• Jenna Elizabeth Tinsley, PT
• Margaret Tobolka

• Diagnostic Radiology Physician in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; 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.