Provider Demographics
NPI:1972684637
Name:SKELETAL DIAGNOSTICS OF SEALY
Entity Type:Organization
Organization Name:SKELETAL DIAGNOSTICS OF SEALY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-352-4983
Mailing Address - Street 1:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-0945
Mailing Address - Country:US
Mailing Address - Phone:979-865-3124
Mailing Address - Fax:
Practice Address - Street 1:526 WARD ST
Practice Address - Street 2:SUITE 135
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-2651
Practice Address - Country:US
Practice Address - Phone:281-352-4983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080922001Medicaid
TX0063BROtherBLUE CROSS
TX0063BROtherBLUE CROSS