Provider Demographics
NPI:1093127516
Name:AIRLINE DIAGNOSIS CENTER LLC
Entity Type:Organization
Organization Name:AIRLINE DIAGNOSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GHOLAMHOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-878-2048
Mailing Address - Street 1:5200 MITCHELLDALE ST
Mailing Address - Street 2:F-27
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-7206
Mailing Address - Country:US
Mailing Address - Phone:832-878-2048
Mailing Address - Fax:713-956-2555
Practice Address - Street 1:5990 AIRLINE DR
Practice Address - Street 2:130A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4233
Practice Address - Country:US
Practice Address - Phone:713-884-8070
Practice Address - Fax:713-884-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty