Provider Demographics
NPI:1629316559
Name:BONE DENSITOMETRY CENTER
Entity Type:Organization
Organization Name:BONE DENSITOMETRY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-512-7055
Mailing Address - Street 1:7900 FANNIN ST
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2934
Mailing Address - Country:US
Mailing Address - Phone:713-512-7000
Mailing Address - Fax:713-512-7027
Practice Address - Street 1:7900 FANNIN ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2934
Practice Address - Country:US
Practice Address - Phone:713-512-7000
Practice Address - Fax:713-512-7027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, PLLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX79778901Medicaid
TX00071FOtherMEDICARE GROUP PTAN