Provider Demographics
NPI:1447284575
Name:GEMINI DIGITAL IMAGING
Entity type:Organization
Organization Name:GEMINI DIGITAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHTANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-682-6655
Mailing Address - Street 1:2704 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6378
Mailing Address - Country:US
Mailing Address - Phone:972-682-6655
Mailing Address - Fax:972-682-6679
Practice Address - Street 1:2704 N GALLOWAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6378
Practice Address - Country:US
Practice Address - Phone:972-682-6655
Practice Address - Fax:972-682-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR227902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0201DCOtherBLUE CROSS BLUE SHIELD
TX00240XMedicare ID - Type Unspecified