Provider Demographics
NPI:1902872088
Name:ENVISION RADIOLOGY OF TEXAS
Entity Type:Organization
Organization Name:ENVISION RADIOLOGY OF TEXAS
Other - Org Name:OUTPATIENT DIAG CENTER AT HUNTERS ROW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-955-4332
Mailing Address - Street 1:8610 EXPLORER DR
Mailing Address - Street 2:300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1058
Mailing Address - Country:US
Mailing Address - Phone:719-955-4140
Mailing Address - Fax:719-955-4148
Practice Address - Street 1:710 HUNTERS ROW CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4001
Practice Address - Country:US
Practice Address - Phone:817-453-7444
Practice Address - Fax:817-453-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK161429901Medicaid
OK161429901Medicaid