NPI age
13 years
Enumerated 2012-12-11
● Active Type 2 · Organization
Boulevard Diagnostic Mgmt Group
Boulevard Diagnostic Mgmt Group is 1 of 640 clinic/center organizations in Texas.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Waller
Operations Manager
Last NPPES update
2012-12-11
Source: monthly bulk 2026-05
How this organization compares
Across 640 active clinic/center providers in Texas.
NPI age
13 years
≈ at median (14 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2012 → 2026
2012-12Enumerated in NPPES
2012
2026
Where they practice
Primary practice location
3120 W Southlake Blvd # 140
Southlake, TX 760926783
Mailing address
3120 W Southlake Blvd # 140
Southlake, TX 760926783
Authorized official
James Waller
Operations Manager
📞 8177410808
Specialties
-
Clinic/Center PrimaryDefinition to come...
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.