Provider Demographics
NPI:1346205093
Name:SOUTHEAST TEXAS IMAGING LLP
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS IMAGING LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIGHTINGALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-729-5400
Mailing Address - Street 1:1323 S 27TH ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6290
Mailing Address - Country:US
Mailing Address - Phone:409-729-5400
Mailing Address - Fax:409-729-4850
Practice Address - Street 1:2555 JIMMY JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77643
Practice Address - Country:US
Practice Address - Phone:409-729-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093888801Medicaid
TXCI4744Medicare PIN
TX00R87CMedicare PIN