Organization
GRAPEVINE IMAGING & PAIN MANAGEMENT CENTER LLC
Active
Other names
Eclipse Imaging Pain Management Center-Grapevine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GAIL S. MAYFIELD (CEO/MANAGING MEMBER)
(817) 479-0800
Entity
Organization
Contact information
Practice address
2401 IRA E WOODS, #600, GRAPEVINE, TX 76051-8631
(817) 488-9991
(817) 488-9992
Mailing address
2401 IRA E WOODS, #600, GRAPEVINE, TX 76051-8631
(817) 488-9991
(817) 488-9992
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R25579
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119DC
BCBS
TX
05
—
303769901
—
TX
01
—
376985800
DOL
TX
01
—
9676331
CIGNA
TX
Enumeration date
08/11/2006
Last updated
05/13/2016
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