1598718835 NPI number — E PET IMAGING XVII, L.P.

Table of content: (NPI 1598718835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598718835 NPI number — E PET IMAGING XVII, L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E PET IMAGING XVII, L.P.
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:
6
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:
1598718835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6021 FAIRMONT PKWY
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77505-4022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-991-4615
Provider Business Mailing Address Fax Number:
281-991-4611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6021 FAIRMONT PKWY
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77505-4022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-991-4615
Provider Business Practice Location Address Fax Number:
281-991-4611
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EYLER
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY OF GENERAL PARTNER
Authorized Official Telephone Number:
615-467-7408

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: 0495DC . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00262796 . This is a "RRMEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com