Provider Demographics
NPI:1497403976
Name:NORTHEAST IMAGING CENTER LLC
Entity Type:Organization
Organization Name:NORTHEAST IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-882-6742
Mailing Address - Street 1:22751 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6021
Mailing Address - Country:US
Mailing Address - Phone:832-882-6742
Mailing Address - Fax:281-664-5899
Practice Address - Street 1:22751 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6021
Practice Address - Country:US
Practice Address - Phone:832-882-6742
Practice Address - Fax:281-664-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology