| Organization Name: | NORTHWEST DIAGNOSTIC CLINIC, PA |
| NPI Number: | 1144615097 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVE MCNEILL (OWNER) |
| Mailing Address: | 8845 Six Pines Dr 2nd Floor Shenandoah |
| State: | TX US |
| Postal Code: | 773802675 |
| Phone Number: | 2813673343 |
| Fax Number: | 2812921409 |
| NPI Enumeration Date: | 03/30/2015 |
| NPI Last Update Date: | 03/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |