Provider Demographics
NPI:1942716220
Name:FAMILY PRACTICE DOCTORS IMAGING CENTER
Entity Type:Organization
Organization Name:FAMILY PRACTICE DOCTORS IMAGING CENTER
Other - Org Name:FAMILY PRACTICE DOCTORS IMAGING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUKUEMEKA
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ORAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-570-2606
Mailing Address - Street 1:1207 NORTH HOUSTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-8018
Mailing Address - Country:US
Mailing Address - Phone:281-570-2606
Mailing Address - Fax:281-570-2011
Practice Address - Street 1:1207 NORTH HOUSTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-8018
Practice Address - Country:US
Practice Address - Phone:281-570-2606
Practice Address - Fax:281-570-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6950261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology