# PREFERRED IMAGING OF FORT WORTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043566011
- **Authorized official:** LAURA KASSA (SR VICE PRESIDENT)
- **Authorized official phone:** (904) 515-0362

## Contact information

- **Practice address:** 851 GRAINGER ST, SUITE 101, FORT WORTH, TX 76104-4645
- **Practice address phone:** (469) 362-6909
- **Practice address fax:** (214) 494-4295
- **Mailing address:** P O BOX 674328, DALLAS, TX 75267-4328
- **Mailing address phone:** (469) 362-6909
- **Mailing address fax:** (214) 494-4295

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | NULL | — |
| 261QR0200X | Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/27/2012
- **Last updated:** 04/06/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 371483401 | — | TX |