Organization
MOODY DIAGNOSTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY RYAN MOODY RDMS, RDCS, RVS (PRESIDENT)
(903) 723-5345
Entity
Organization
Contact information
Practice address
104 TRINITY PLACE, PALESTINE, TX 75801
(903) 723-5345
(903) 723-5343
Mailing address
PO BOX 1838, PALESTINE, TX 75802-1838
(903) 723-5345
(903) 723-5343
Taxonomy
Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0013DC
BCBS
TX
05
—
146693001
—
TX
Enumeration date
01/19/2007
Last updated
07/26/2010
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