Organization
SPEED OF LIGHT XRAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VANESSA KAY MAGNESS R.T.(R) (OWNER/OPERATOR)
(903) 363-9583
Entity
Organization
Contact information
Practice address
3200 TROUP HWY STE 130, TYLER, TX 75701-8330
(903) 316-6611
(903) 363-9583
Mailing address
3200 TROUP HWY STE 130, TYLER, TX 75701-8330
(903) 363-9583
(903) 363-9583
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218271901
—
TX
01
—
459919
MEDICARE PTAN
TX
Enumeration date
11/30/2010
Last updated
08/13/2020
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