Organization
PREFERRED IMAGING OF FORT WORTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA KASSA (SR VICE PRESIDENT)
(904) 515-0362
Entity
Organization
Contact information
Practice address
851 GRAINGER ST, SUITE 101, FORT WORTH, TX 76104-4645
(469) 362-6909
(214) 494-4295
Mailing address
P O BOX 674328, DALLAS, TX 75267-4328
(469) 362-6909
(214) 494-4295
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371483401
—
TX
Enumeration date
07/27/2012
Last updated
04/06/2022
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