PHOTON IMAGING, PLLC (NPI# 1225637820) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225637820 |
| Entity Type | Organization |
| Organization Name | PHOTON IMAGING, PLLC |
| Practice Address |
515 W 12th St Texarkana TX 75501-4416 |
| Mailing Address |
20148 Fm 449 Longview TX 75605-7731 |
| Practice Telephone | 9037355000 |
| Mailing Telephone | 9037363179 |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2020-11-02 |
| Authorized Official Name | JOHN C CAMPBELL (VICE PRESIDENT) |
| Authorized Official Telephone | 9037363179 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| Street Address |
515 W 12TH ST |
| City | TEXARKANA |
| State | TX |
| Zip Code | 75501-4416 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649243353 | Encompass Health Rehabilitation Hospital of Texarkana, Inc. | Rehabilitation Hospital | 515 W 12th St, Texarkana, TX 75501 | 2006-02-12 |
| 1083658462 | Healthsouth Rehabilitation Hospital of Texarkana Inc | Home Health | 515 W 12th St, Texarkana, TX 75501-4416 | 2006-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598227951 | Shayla Lasonde Williams | Licensed Vocational Nurse | 409 Tracey Ave, Wake Village, TX 75501 | 2019-04-04 |
| 1861900904 | Tiffany Anne Baugus | Nurse Practitioner | 2600 St. Michael Drive, Texarkana, TX 75501 | 2018-01-10 |
| 1104363258 | Brent Willis | Nurse Anesthetist, Certified Registered | 203 La Grange Dr., Texarkana, TX 75501 | 2017-01-27 |
| 1154627644 | Patricia Maree Baker | Counselor | 1001 Texas Blvd., Suite 106, Texarkana, TX 75501 | 2011-02-01 |
| 1730323452 | William Leonard | Occupational Therapy Assistant | 2108 5th Street, Bridgeport, TX 75501 | 2009-04-24 |
| 1700071552 | Roger House Md, Psychiatric Services | Case Management | 2401 Summerhill Rd., Suite A, Texarkana, TX 75501 | 2007-09-13 |
| 1134248271 | Brent Bultemeier Pa | Chiropractor | 3207 New Boston Road, Texarkana, TX 75501 | 2007-03-28 |
| 1346395977 | Sharon E. Moore | Registered Nurse | Youree Drive, Shreveport, LA 75501 | 2007-01-24 |
| 1962553024 | Leary Independent School District | Local Education Agency (LEA) | 9500 W. New Boston Rd, Texarkana, TX 75501 | 2007-01-16 |
| 1780787390 | Christina Michelle Griffin | Physical Therapist | 1315 Walnut, Temple Memorial Rehabiliation Ctr, Texarkana, TX 75501 | 2006-09-07 |
| Find all providers in zip 75501 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346356573 | Medical Investments of Texarkana LLC | Radiology | 4303 Texas Blvd Ste 8, Texarkana, TX 75503-3094 | 2006-08-21 |
| 1588770721 | Texarkana Mri, Lp | Radiology | 4303 Texas Blvd # No.8, Texarkana, TX 75503-3097 | 2006-08-21 |
| 1912994708 | Larry M Peebles | Radiology | 4102 Richmond Mdws, Texarkana, TX 75503-0067 | 2005-10-05 |
| 1245231885 | William Randall Brown | Radiology | 5508 Summerhill Rd, Texarkana, TX 75503-1822 | 2005-08-04 |
| 1235503319 | William Beaty | Radiology | 5508 Summerhill Rd, Texarkana, TX 75503-1822 | 2015-11-30 |
| 1548681042 | Samuel Thomas Gatzert | Radiology | 2600 Saint Michael Dr, Texarkana, TX 75503-2372 | 2013-12-31 |
| 1124286737 | Joshua Gordon Martin | Radiology | 4102 Richmond Mdws, Texarkana, TX 75503-0067 | 2008-05-30 |
| 1609049956 | Robert Samuel Mcginnis IIi | Radiology | 5002 Cowhorn Creek Rd, Texarkana, TX 75503-9766 | 2008-04-08 |
| 1437320256 | Christian Allen Sell | Radiology | 4102 Richmond Mdws, Texarkana, TX 75503-0067 | 2008-03-19 |
| 1780735845 | Trevor L Clayton | Radiology | 5002 Cowhorn Creek Rd, Texarkana, TX 75503-9766 | 2007-01-16 |
| Find all providers in TEXARKANA | ||||
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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.