Provider Demographics
NPI:1033160015
Name:MONTICELLO DIAGNOSTIC IMAGING LP
Entity type:Organization
Organization Name:MONTICELLO DIAGNOSTIC IMAGING LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-377-3800
Mailing Address - Street 1:7668 ELDORADO PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5753
Mailing Address - Country:US
Mailing Address - Phone:817-377-3800
Mailing Address - Fax:817-377-3801
Practice Address - Street 1:3712 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2536
Practice Address - Country:US
Practice Address - Phone:817-377-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151706201Medicaid
TXCK2949Medicare PIN
TX00305TMedicare PIN