Provider Demographics
NPI:1043638109
Name:SAFEWAY IMAGING LLC
Entity Type:Organization
Organization Name:SAFEWAY IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZESHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-208-3344
Mailing Address - Street 1:PO BOX 2064
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-9064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3270 SOUTH LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5201
Practice Address - Country:US
Practice Address - Phone:281-208-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile