# METHODIST DIAGNOSTIC IMAGING

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** COVENANT DIAGNOSTIC IMAGING
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013914613
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 3525 19TH ST, LUBBOCK, TX 79410-1202
- **Practice address phone:** (806) 792-2767
- **Practice address fax:** (806) 791-6709
- **Mailing address:** PO BOX 2190, LUBBOCK, TX 79408-2190
- **Mailing address phone:** (806) 792-2767
- **Mailing address fax:** (806) 791-6709

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085B0100X | Body Imaging Physician | N/A | TX | — |
| 261QR0200X | Radiology Clinic/Center | N/A | TX | Yes |
| 293D00000X | Physiological Laboratory | N/A | TX | — |

## Other

- **Enumeration date:** 06/29/2005
- **Last updated:** 05/07/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 103173100 | FIRSTCARE | TX |
| 05 | — | 121741601 | — | TX |
| 01 | — | 121741603 | CROSSOVERMEDICAID | TX |
| 01 | — | DN6474 | RAILROAD MEDICARE | — |
| 05 | — | G7966 | — | NM |
| 01 | — | OOF91Y | BLUE CROSS | TX |