BOULEVARD DIAGNOSTIC MANAGEMENT GROUP, LLC (NPI# 1194061135) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194061135 |
| Entity Type | Organization |
| Organization Name | BOULEVARD DIAGNOSTIC MANAGEMENT GROUP, LLC |
| Practice Address |
3120 W Southlake Blvd Southlake TX 76092-6783 |
| Practice Telephone | 8177410808 |
| Mailing Telephone | 8177410808 |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2012-12-19 |
| Authorized Official Name | MR. JAMES AUBREY WALLER (MANAGING MANAGER) |
| Authorized Official Telephone | 8175287044 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1200X |
Clinic/Center Specialization: Magnetic Resonance Imaging (MRI) |
Ambulatory Health Care Facilities |
| Street Address |
3120 W SOUTHLAKE BLVD |
| City | SOUTHLAKE |
| State | TX |
| Zip Code | 76092-6783 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528148715 | Aboudib Advanced Imaging Inc | Radiology | 3120 W Southlake Blvd, Suite 140, Southlake, TX 76092 | 2006-10-16 |
| 1538520770 | Allison Andrews | Nurse Practitioner | 3120 W Southlake Blvd, Ste 100, Southlake, TX 76092-6783 | 2016-03-16 |
| 1144663832 | Elite View Imaging, LLC | Clinic/Center | 3120 W Southlake Blvd, Suite 140, Southlake, TX 76092-6783 | 2013-04-11 |
| 1417390360 | Elite View Imaging, LLC | Clinic/Center | 3120 W Southlake Blvd, Suite 140, Southlake, TX 76092-6783 | 2013-04-10 |
| 1639367329 | Tcsd Clinic LLC | Clinic/Center | 3120 W Southlake Blvd, Suite 100, Southlake, TX 76092-6783 | 2007-10-09 |
| 1184743247 | Nocturna Sleep Therapy Lp | Durable Medical Equipment & Medical Supplies | 3120 W Southlake Blvd, Suite 120, Southlake, TX 76092-6783 | 2007-03-28 |
| 1265578520 | Nocturna of Keller Lp | Clinic/Center | 3120 W Southlake Blvd, Suite 100, Southlake, TX 76092-6783 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730718990 | Elizabeth Beazley | Family Medicine | 1050 E. Hwy 114 Suite 100, Southlake, TX 76092 | 2020-04-08 |
| 1518508894 | Arbor Pediatrics, Pllc | Pediatrics | 1130 N Kimball Ave, Southlake, TX 76092 | 2019-10-08 |
| 1346882685 | Gs Ortho Assists, Pllc | Physician Assistant | 2600 East Southlake Boulevard Suite 120, Southlake, TX 76092 | 2019-10-08 |
| 1609340496 | Rebecca Leigh Lander | Physician Assistant | 1170 N Carroll Ave., Southlake, TX 76092 | 2019-01-15 |
| 1225506223 | Physicians Wellness Associates Pllc | Family Medicine | 1920 East State Highway 114, Southlake, TX 76092 | 2018-11-07 |
| 1740762459 | Brandi L. Barker | Chiropractor | 590 N. Kimball Ave, Suite 140, Southlake, TX 76092 | 2018-08-30 |
| 1033699228 | Julie A. Seeber | Physical Therapy Assistant | 170 Stonebridge Lane, Southlake, TX 76092 | 2018-08-16 |
| 1992281364 | Alayna Powers | Nurse Practitioner | 900 E Southlake Blvd Ste 300, Southlake, TX 76092 | 2018-07-18 |
| 1346732153 | Amrittej Singh Virk | Dentist | 630 N Kimball Ave Ste 110, Southlake, TX 76092 | 2018-06-06 |
| 1740779594 | Radiant Family Dental Pllc | Dentist | 2012 Southlake Glen Dr., Southlake, TX 76092 | 2018-05-08 |
| Find all providers in zip 76092 | ||||
| Taxonomy Code | 261QM1200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Magnetic Resonance Imaging (MRI) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013518869 | Texas Advanced Imaging LLC | Clinic/Center | 4907 Sandhill Dr Ste D, Sugar Land, TX 77479-5352 | 2020-11-06 |
| 1801401229 | Jason A Ramsey M D P A | Clinic/Center | 8214 Milwaukee Ave Ste 200, Lubbock, TX 79424-0923 | 2020-09-11 |
| 1053940494 | Alliance Mri Woodforest LLC | Clinic/Center | 750 Fish Creek Thoroughfare, Suite 180, Montgomery, TX 77316 | 2020-04-07 |
| 1578199733 | Prestige Diagnostic Imaging LLC | Clinic/Center | 11240 Vista Del Sol Dr Ste A, El Paso, TX 79936-5236 | 2020-03-19 |
| 1740815364 | Prestige Diagnostic Imaging | Clinic/Center | 11240 Vista Del Sol Dr., El Paso, TX 79936-5236 | 2020-03-04 |
| 1457991689 | Inclusive Diagnostics, Inc | Clinic/Center | 12000 Richmond Ave Ste 125, Houston, TX 77082-2431 | 2020-01-15 |
| 1467006338 | Carroll Ave Imaging LLC | Clinic/Center | 1015 N Carroll Ave Ste 2001, Dallas, TX 75204-6613 | 2019-07-30 |
| 1316404635 | Alliance Mri Pearland LLC | Clinic/Center | 1910 Country Place Pkwy Ste 154, Pearland, TX 77584-2144 | 2019-02-22 |
| 1073080875 | North Texas Advanced Imaging LLC | Clinic/Center | 6160 Windhaven Pkwy Ste 100, Plano, TX 75093-2143 | 2018-10-30 |
| 1275014565 | Trinity Center Open Mri | Clinic/Center | 1110 Marshall Street, Laredo, TX 78045 | 2018-08-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.