Provider Demographics
NPI:1821411596
Name:AMERICA'S ER SITE 001 IMAGING AND LABORATORY SERVICES, LLC
Entity Type:Organization
Organization Name:AMERICA'S ER SITE 001 IMAGING AND LABORATORY SERVICES, LLC
Other - Org Name:AMERICA'S ER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FEANNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-895-6625
Mailing Address - Street 1:32784 FM 2978
Mailing Address - Street 2:SUITE C
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354
Mailing Address - Country:US
Mailing Address - Phone:832-895-6625
Mailing Address - Fax:877-261-3390
Practice Address - Street 1:11200 BROADWAY ST
Practice Address - Street 2:SUITE 2743
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9785
Practice Address - Country:US
Practice Address - Phone:832-895-6625
Practice Address - Fax:877-261-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0200X
TX24932291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical Laboratory