Provider Demographics
NPI:1164779864
Name:DIAGNOSTIC ASSOCIATES OF TEXAS, P.A.
Entity Type:Organization
Organization Name:DIAGNOSTIC ASSOCIATES OF TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-384-8455
Mailing Address - Street 1:17484 NORTHWEST FWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77040-1002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17484 NORTHWEST FWY
Practice Address - Street 2:SUITE 212
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77040-1002
Practice Address - Country:US
Practice Address - Phone:281-793-6998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty