Provider Demographics
NPI:1790714087
Name:TOMBALL IMAGING, LLP
Entity Type:Organization
Organization Name:TOMBALL IMAGING, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TROCKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-453-7917
Mailing Address - Street 1:24727 TOMBALL PARKWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375
Mailing Address - Country:US
Mailing Address - Phone:281-516-0660
Mailing Address - Fax:281-440-2020
Practice Address - Street 1:24727 TOMBALL PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-516-0660
Practice Address - Fax:281-440-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X918Medicare PIN