Provider Demographics
NPI:1003111352
Name:GULF DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:GULF DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVORA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-457-2167
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-1769
Mailing Address - Country:US
Mailing Address - Phone:832-457-2167
Mailing Address - Fax:281-715-4545
Practice Address - Street 1:1051 PINELOCH DR STE 700
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2738
Practice Address - Country:US
Practice Address - Phone:832-457-2167
Practice Address - Fax:281-715-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service