Provider Demographics
NPI:1568444370
Name:GAIL L BURLESON
Entity Type:Organization
Organization Name:GAIL L BURLESON
Other - Org Name:ULTRASOUND SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURLESON
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:713-668-7481
Mailing Address - Street 1:6611 S RICE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4012
Mailing Address - Country:US
Mailing Address - Phone:281-240-0448
Mailing Address - Fax:713-668-2316
Practice Address - Street 1:6611 S RICE AVE
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4012
Practice Address - Country:US
Practice Address - Phone:281-240-0448
Practice Address - Fax:713-668-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM00602261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093943101Medicaid
TX00N30NMedicare PIN
TX093943101Medicaid