Organization
BROAD PARK IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKI BAILLEU BS (ADMINISTRATOR)
(817) 690-8873
Entity
Organization
Contact information
Practice address
1750 BROAD PARK CIR S, SUITE 300, MANSFIELD, TX 76063-7832
(682) 200-2517
(682) 200-2518
Mailing address
1750 BROAD PARK CIR S, SUITE 300, MANSFIELD, TX 76063-7832
(682) 200-2517
(682) 200-2518
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
01/05/2010
Last updated
01/05/2010
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