NPIMap

Organization Active NPI

Boulevard Diagnostic MGMT Group

  • Radiology Clinic/Center
  • Southlake, TX
National Provider Identifier
1922343342
Registry record updated Dec 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
BOULEVARD DIAGNOSTIC MGMT GROUP
Practice address
3120 W Southlake Blvd # 140
Southlake, TX 76092-6783
Phone
(817) 741-0808
Fax
(817) 741-0841
NPI assigned
Dec 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2012

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

Authorized official

Name
James Waller
Title
Operations Manager
Phone
(817) 741-0808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

3120 W Southlake Blvd # 140
Southlake, TX 76092-6783

Mailing address

3120 W Southlake Blvd # 140
Southlake, TX 76092-6783

National Provider Directory

National Provider Directory
Tax ID family
Boulevard Diagnostic Management Group LLC2 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": "1355184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355184000000",
    "number": "1922343342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 W SOUTHLAKE BLVD # 140",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 W SOUTHLAKE BLVD # 140",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926783",
            "telephone_number": "817-741-0808",
            "fax_number": "817-741-0841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD DIAGNOSTIC MGMT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-11",
        "last_updated": "2012-12-11",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "817-741-0808"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; 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.