Provider Demographics
NPI:1063817203
Name:OAKRIDGE IMAGING LLC
Entity Type:Organization
Organization Name:OAKRIDGE IMAGING LLC
Other - Org Name:GO IMAGING CENTRAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-705-0060
Mailing Address - Street 1:3301 S SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3320
Mailing Address - Country:US
Mailing Address - Phone:713-874-0111
Mailing Address - Fax:713-874-0555
Practice Address - Street 1:3301 S SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3320
Practice Address - Country:US
Practice Address - Phone:713-874-0111
Practice Address - Fax:713-874-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX399627Medicare PIN