Provider Demographics
NPI:1730573312
Name:USMD DIAGNOSTIC SERVICES, LLC
Entity type:Organization
Organization Name:USMD DIAGNOSTIC SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PPM
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-847-0712
Mailing Address - Street 1:PO BOX 678168
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8168
Mailing Address - Country:US
Mailing Address - Phone:972-847-0712
Mailing Address - Fax:817-514-5246
Practice Address - Street 1:811 W. I-20
Practice Address - Street 2:SUITE G-26
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-3252
Practice Address - Country:US
Practice Address - Phone:817-514-5200
Practice Address - Fax:817-514-5246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USMD DIAGNOSTIC SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-23
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX431832Medicare PIN