Provider Demographics
NPI:1548529449
Name:LIVING WELL DIAGNOSTICS IMAGING, LLC
Entity type:Organization
Organization Name:LIVING WELL DIAGNOSTICS IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ESTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-575-3011
Mailing Address - Street 1:5048 TENNYSON PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3067
Mailing Address - Country:US
Mailing Address - Phone:469-575-3011
Mailing Address - Fax:469-575-3011
Practice Address - Street 1:5048 TENNYSON PKWY STE 250
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3067
Practice Address - Country:US
Practice Address - Phone:469-575-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances