Provider Demographics
NPI:1417152919
Name:RAYTEL NUCLEAR IMAGING - W.HOUSTON, INC.
Entity Type:Organization
Organization Name:RAYTEL NUCLEAR IMAGING - W.HOUSTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLANEGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-831-1112
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-0987
Mailing Address - Country:US
Mailing Address - Phone:800-367-1095
Mailing Address - Fax:860-298-6127
Practice Address - Street 1:7 WATERSIDE XING
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1540
Practice Address - Country:US
Practice Address - Phone:800-367-1095
Practice Address - Fax:860-298-6127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTNC04Medicare PIN