# BOULEVARD DIAGNOSTIC MGMT GROUP

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

## Provider details

- **NPI number:** 1922343342
- **Authorized official:** JAMES WALLER (OPERATIONS MANAGER)
- **Authorized official phone:** (817) 741-0808

## Contact information

- **Practice address:** 3120 W SOUTHLAKE BLVD \# 140, SOUTHLAKE, TX 76092-6783
- **Practice address phone:** (817) 741-0808
- **Practice address fax:** (817) 741-0841
- **Mailing address:** 3120 W SOUTHLAKE BLVD \# 140, SOUTHLAKE, TX 76092-6783

## Taxonomy

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

## Other

- **Enumeration date:** 12/11/2012
- **Last updated:** 12/11/2012