NPIMap

Organization Active NPI

Liberty Medical Diagnostics Center

  • Preferred Provider Organization
  • McKinney, TX
National Provider Identifier
1861893760
Registry record updated Sep 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
N6605 Issued in TX
Legal business name
LIBERTY MEDICAL DIAGNOSTICS CENTER
Practice address
1416 Pecan Valley Dr
McKinney, TX 75070-8322
Phone
(214) 396-7725
Fax
(469) 453-3192
NPI assigned
Sep 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2014

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

Authorized official

Name
Mr. Dustin L Ray, M.D.
Title
Owner
Phone
(214) 396-7725

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X N6605 TX Primary

Addresses

Primary practice location

1416 Pecan Valley Dr
McKinney, TX 75070-8322

Mailing address

1416 Pecan Valley Dr
McKinney, TX 75070-8322
Phone (214) 396-7725

National Provider Directory

National Provider Directory
Tax ID family
Liberty Medical Diagnostics Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1410307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410307200000",
    "number": "1861893760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 PECAN VALLEY DR",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750708322",
            "telephone_number": "214-396-7725",
            "fax_number": "469-453-3192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 PECAN VALLEY DR",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750708322",
            "telephone_number": "214-396-7725",
            "fax_number": "469-453-3192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICAL DIAGNOSTICS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-10",
        "last_updated": "2014-09-10",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-396-7725",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "TX",
            "license": "N6605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinney, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; 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.