Provider Demographics
NPI:1356151799
Name:BETHANY MOBILE DIAGNOSTIC IMAGING
Entity type:Organization
Organization Name:BETHANY MOBILE DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:BESHAWORED
Authorized Official - Suffix:
Authorized Official - Credentials:RT CT/MR
Authorized Official - Phone:469-605-8179
Mailing Address - Street 1:5525 DORCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4494
Mailing Address - Country:US
Mailing Address - Phone:469-605-8179
Mailing Address - Fax:
Practice Address - Street 1:5525 DORCHESTER LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-4494
Practice Address - Country:US
Practice Address - Phone:469-605-8179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier