Provider Demographics
NPI:1275297103
Name:PHOENIX PRECISION MEDICAL, LLC
Entity Type:Organization
Organization Name:PHOENIX PRECISION MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-250-0313
Mailing Address - Street 1:1431 WIRT RD STE 149
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-4916
Mailing Address - Country:US
Mailing Address - Phone:281-250-0313
Mailing Address - Fax:888-789-4755
Practice Address - Street 1:1458 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4669
Practice Address - Country:US
Practice Address - Phone:281-250-0313
Practice Address - Fax:888-789-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty