# BROAD PARK IMAGING, LLC

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

## Provider details

- **NPI number:** 1467782052
- **Authorized official:** JACKI BAILLEU BS (ADMINISTRATOR)
- **Authorized official phone:** (817) 690-8873

## Contact information

- **Practice address:** 1750 BROAD PARK CIR S, SUITE 300, MANSFIELD, TX 76063-7832
- **Practice address phone:** (682) 200-2517
- **Practice address fax:** (682) 200-2518
- **Mailing address:** 1750 BROAD PARK CIR S, SUITE 300, MANSFIELD, TX 76063-7832
- **Mailing address phone:** (682) 200-2517
- **Mailing address fax:** (682) 200-2518

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 01/05/2010
- **Last updated:** 01/05/2010