Provider Demographics
NPI:1578766408
Name:PHOENIX DIAGNOSTIC ENTERPRISES PLLC
Entity Type:Organization
Organization Name:PHOENIX DIAGNOSTIC ENTERPRISES PLLC
Other - Org Name:DIAGNOSTIC CLINIC OF HOUSTON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-797-9191
Mailing Address - Street 1:1200 BINZ ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6926
Mailing Address - Country:US
Mailing Address - Phone:713-797-9191
Mailing Address - Fax:713-986-1353
Practice Address - Street 1:1200 BINZ ST STE 1100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6926
Practice Address - Country:US
Practice Address - Phone:713-797-9191
Practice Address - Fax:713-986-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN
TX00X835Medicare PIN