Etsub Negussie Haileselassie

Primary specialty

Body Imaging PhysicianTaxonomy code 2085B0100X

License

454534 Issued in TX

Practice address

1702 Arbor Creek Dr.
Garland, TX 75040

Phone

(469) 269-7259

NPI assigned

Aug 21, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Et Portable X-Ray PLLC

  • Mobile Radiology Clinic/Center
  • Garland, TX
  • NPI 1730745928
  NPD Authorized official

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556582400000",
    "number": "1801312947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 ARBOR CREEK DR",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750408912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 ARBOR CREEK DR.",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "75040",
            "telephone_number": "469-269-7259"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10641 Steppington Dr",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752304676",
            "country_code": "US",
            "telephone_number": "469-269-7259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAILESELASSIE",
        "first_name": "ETSUB",
        "middle_name": "NEGUSSIE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-21",
        "last_updated": "2019-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "TX",
            "license": "454534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haba Heart LLC
• Lynette Hablinski
• Hadeflow Alpha LLC
• Charlotte Anne Hagy, PA-C
• Haider Health Services PLLC
• Bridget Annabess Hale, M.S. CCC-SLP
• Lauren Hale, RN
• Austin Haley
• Carlton Marshall Haley, M.D.
• John Marshall Haley, M.D.

• Body Imaging Physician in Garland, TX
• Providers in Garland, TX by specialty
• Body Imaging Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; 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.