1366495244 NPI number — E PLUS PET IMAGING XI LP

Table of content: (NPI 1366495244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366495244 NPI number — E PLUS PET IMAGING XI LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E PLUS PET IMAGING XI LP
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:
PET IMAGING OF SUGAR LAND
Provider Other Organization Name Type Code:
3
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:
1366495244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17320 W GRAND PKWY S
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-7902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-595-2713
Provider Business Mailing Address Fax Number:
832-595-2714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17320 W GRAND PKWY S
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-7902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-595-2713
Provider Business Practice Location Address Fax Number:
832-595-2714
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RHYMER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
COO OF GENERAL PARTNER
Authorized Official Telephone Number:
615-467-7415

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0448DC . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00212622 . This is a "RRMEDICARE" identifier . This identifiers is of the category "OTHER".




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