Provider Demographics
NPI:1497198147
Name:ELITE VIEW IMAGING, LLC
Entity type:Organization
Organization Name:ELITE VIEW IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-528-7044
Mailing Address - Street 1:3120 W SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6783
Mailing Address - Country:US
Mailing Address - Phone:817-741-0808
Mailing Address - Fax:817-741-0841
Practice Address - Street 1:1750 BROAD PARK CIR S
Practice Address - Street 2:SUITE 300
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7832
Practice Address - Country:US
Practice Address - Phone:682-200-2517
Practice Address - Fax:682-200-2518
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE VIEW IMAGING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR33761-000261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology