Organization
MEDICAL IMAGING DIAGNOSTIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES WALTON LIVELY MD (PRESIDENT)
(361) 906-0969
Entity
Organization
Contact information
Practice address
700 N AIRPORT RD, ALICE, TX 78332
(361) 661-8000
Mailing address
PO BOX 1888, GREENVILLE, TX 75403-1888
(800) 945-2455
(903) 453-2541
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127265002
—
TX
Enumeration date
04/18/2006
Last updated
04/09/2008
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