Provider Demographics
NPI:1508463415
Name:CT MEDICAL GROUP
Entity Type:Organization
Organization Name:CT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YAZOMAM
Authorized Official - Middle Name:
Authorized Official - Last Name:IBEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-435-2374
Mailing Address - Street 1:1004 CAVERN DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4419
Mailing Address - Country:US
Mailing Address - Phone:214-435-2374
Mailing Address - Fax:
Practice Address - Street 1:11901 SHADOW CREEK PKWY STE 111B
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7346
Practice Address - Country:US
Practice Address - Phone:214-435-2374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Multi-Specialty