Provider Demographics
NPI:1841765443
Name:DM MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:DM MEDICAL IMAGING LLC
Other - Org Name:DM MEDICAL IMAGING LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:XIUMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-971-2249
Mailing Address - Street 1:9606 BEVLYN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-4502
Mailing Address - Country:US
Mailing Address - Phone:346-971-2249
Mailing Address - Fax:
Practice Address - Street 1:10021 MAIN ST STE B1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5253
Practice Address - Country:US
Practice Address - Phone:346-971-2249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ8695OtherDIAGNOSTIC RADIOLOGY