Provider Demographics
NPI:1710988373
Name:WOODLAKE IMAGING, L.L.C.
Entity Type:Organization
Organization Name:WOODLAKE IMAGING, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZAMIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-242-6200
Mailing Address - Street 1:9600 WESTHEIMER RD
Mailing Address - Street 2:12A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3205
Mailing Address - Country:US
Mailing Address - Phone:832-242-6200
Mailing Address - Fax:832-242-6201
Practice Address - Street 1:9600 WESTHEIMER RD
Practice Address - Street 2:12A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3205
Practice Address - Country:US
Practice Address - Phone:832-242-6200
Practice Address - Fax:832-242-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0333DCOtherBCBS
TX0333DCOtherBCBS