Provider Demographics
NPI:1902835895
Name:PROFESSIONAL IMAGING, PLLC
Entity Type:Organization
Organization Name:PROFESSIONAL IMAGING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BAUMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-272-6277
Mailing Address - Street 1:6078 BRIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1126
Mailing Address - Country:US
Mailing Address - Phone:805-293-1573
Mailing Address - Fax:805-275-1842
Practice Address - Street 1:1717 ROTARY DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5235
Practice Address - Country:US
Practice Address - Phone:866-676-6277
Practice Address - Fax:281-272-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007115656OtherAETNA
TX0073MLOtherBC/BS OF TEXAS
TXDD1023OtherRAILROAD MEDICARE
TX172298501Medicaid
TX00613YMedicare ID - Type Unspecified