Provider Demographics
NPI:1245759141
Name:LONG LIFE IMAGING, LLC
Entity Type:Organization
Organization Name:LONG LIFE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALLISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS (AE), RVT (VT)
Authorized Official - Phone:281-865-0044
Mailing Address - Street 1:957 NASA PKWY # 1041
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3039
Mailing Address - Country:US
Mailing Address - Phone:346-261-2341
Mailing Address - Fax:
Practice Address - Street 1:957 NASA PKWY # 1041
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3039
Practice Address - Country:US
Practice Address - Phone:346-261-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier