Provider Demographics
NPI:1245396969
Name:LAKESIDE MRI & DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:LAKESIDE MRI & DIAGNOSTIC CENTER
Other - Org Name:VAIBHAV INTERNATIONAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULHUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-633-7331
Mailing Address - Street 1:PO BOX 890313
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-0313
Mailing Address - Country:US
Mailing Address - Phone:281-338-5575
Mailing Address - Fax:281-554-8407
Practice Address - Street 1:17360 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4133
Practice Address - Country:US
Practice Address - Phone:281-338-5575
Practice Address - Fax:281-554-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0880528-02Medicaid
TX0088052801Medicaid
FTX064Medicare PIN