Provider Demographics
NPI:1366977449
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:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:COLEMAN
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-493-4015
Mailing Address - Street 1:5450 CLEARFORK MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3559
Mailing Address - Country:US
Mailing Address - Phone:817-505-0222
Mailing Address - Fax:817-510-3690
Practice Address - Street 1:5450 CLEARFORK MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3559
Practice Address - Country:US
Practice Address - Phone:817-505-0222
Practice Address - Fax:817-510-3690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USMD HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-26
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No293D00000XLaboratoriesPhysiological Laboratory