Provider Demographics
NPI:1417182338
Name:CAPTAIN DIAGNOSTIC AND IMAGING CENTER INC.
Entity Type:Organization
Organization Name:CAPTAIN DIAGNOSTIC AND IMAGING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:UMAWA
Authorized Official - Middle Name:O
Authorized Official - Last Name:IMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-607-2194
Mailing Address - Street 1:9888 BISSONNET ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8247
Mailing Address - Country:US
Mailing Address - Phone:832-607-2194
Mailing Address - Fax:713-541-5028
Practice Address - Street 1:9888 BISSONNET ST
Practice Address - Street 2:SUITE 290
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8247
Practice Address - Country:US
Practice Address - Phone:832-607-2194
Practice Address - Fax:713-541-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty