Provider Demographics
NPI:1255624847
Name:HOUSTON PREMIER RADIOLOGY CENTER INC.
Entity type:Organization
Organization Name:HOUSTON PREMIER RADIOLOGY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SALIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-464-8200
Mailing Address - Street 1:12853 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4807
Mailing Address - Country:US
Mailing Address - Phone:281-464-8200
Mailing Address - Fax:281-464-4343
Practice Address - Street 1:12853 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4807
Practice Address - Country:US
Practice Address - Phone:281-464-8200
Practice Address - Fax:281-464-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR35180293D00000X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288686301Medicaid
TXFTXUVCN1Medicare Oscar/Certification