Provider Demographics
NPI:1861541047
Name:CLEARSKY MRI & DIAGNOSTIC AT DENTON
Entity type:Organization
Organization Name:CLEARSKY MRI & DIAGNOSTIC AT DENTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-328-3333
Mailing Address - Street 1:PO BOX 814230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75381-4230
Mailing Address - Country:US
Mailing Address - Phone:214-328-3333
Mailing Address - Fax:214-328-3330
Practice Address - Street 1:3118 LAS COLINAS DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-3422
Practice Address - Country:US
Practice Address - Phone:940-387-1500
Practice Address - Fax:940-566-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0383DCOtherBLUE CROSS
TXFTA041Medicare PIN