Organization
ADELAIDE DIAGNOSTIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACKSON JACOB (GENERAL MANAGER)
(214) 328-3333
Entity
Organization
Contact information
Practice address
2692 W WALNUT ST, SUITE #108, GARLAND, TX 75042-6474
(214) 328-3333
(214) 328-3330
Mailing address
1123 WESTMINISTER AVE, MURPHY, TX 75094-4158
(214) 328-3333
(214) 328-3330
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
J6228
TX
293D00000X
Physiological Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0623DC
BC/BS
TX
Enumeration date
09/20/2006
Last updated
02/19/2008
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