1306068853 NPI number — US DIAGNOSTIC IMAGING

Table of content: AKIRA STUCKEY MA, LCMHC (NPI 1609919000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306068853 NPI number — US DIAGNOSTIC IMAGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US DIAGNOSTIC IMAGING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306068853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1252
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77497-1252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-250-7571
Provider Business Mailing Address Fax Number:
832-487-8033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8303 SW FWY
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-777-5444
Provider Business Practice Location Address Fax Number:
832-487-8033
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADESINA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
821-250-7571

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180458501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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