Provider Demographics
NPI:1598718835
Name:E PET IMAGING XVII, L.P.
Entity Type:Organization
Organization Name:E PET IMAGING XVII, L.P.
Other - Org Name:PET IMAGING OF HOUSTON - SOUTHEAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY OF GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:EYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-467-7408
Mailing Address - Street 1:6021 FAIRMONT PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4022
Mailing Address - Country:US
Mailing Address - Phone:281-991-4615
Mailing Address - Fax:281-991-4611
Practice Address - Street 1:6021 FAIRMONT PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4022
Practice Address - Country:US
Practice Address - Phone:281-991-4615
Practice Address - Fax:281-991-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0495DCOtherBLUE CROSS/BLUE SHIELD
P00262796OtherRRMEDICARE
P00262796OtherRRMEDICARE