Provider Demographics
NPI:1083840771
Name:ST. MATTHEW DIAGNOSTIC CLINIC, INC.
Entity Type:Organization
Organization Name:ST. MATTHEW DIAGNOSTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-877-3465
Mailing Address - Street 1:7111 HARWIN DR STE 125
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2130
Mailing Address - Country:US
Mailing Address - Phone:832-877-3465
Mailing Address - Fax:713-784-1725
Practice Address - Street 1:7111 HARWIN DR STE 125
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2130
Practice Address - Country:US
Practice Address - Phone:832-877-3465
Practice Address - Fax:713-784-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Multi-Specialty