Organization
ABOUDIB ADVANCED IMAGING INC
Active
Other names
Advanced Imaging Inc
Organization subpart
No
Provider details
NPI number
Authorized official
TONY G ABOUDIB DC (PRESIDENT)
(817) 300-6481
Entity
Organization
Contact information
Practice address
3120 W SOUTHLAKE BLVD, SUITE 140, SOUTHLAKE, TX 76092
(817) 741-0808
(817) 741-0841
Mailing address
PO BOX 5456, TRAVERSE CITY, MI 49696
(817) 300-6481
(231) 421-5215
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R26088
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090DC
BLUE CROSS
—
05
—
088049401
—
TX
01
—
376899000
DEPARTMENT OF LABOR
TX
01
—
P00012585
RAILROAD MEDICARE
—
Enumeration date
10/16/2006
Last updated
12/03/2010
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