Provider Demographics
NPI:1336419589
Name:RAYFORD DIAGNOSTIC LEASING LLC
Entity Type:Organization
Organization Name:RAYFORD DIAGNOSTIC LEASING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:G
Authorized Official - Last Name:GHANEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-419-1599
Mailing Address - Street 1:25440 I-45 NORTH
Mailing Address - Street 2:SUITE 300
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1343
Mailing Address - Country:US
Mailing Address - Phone:281-419-1599
Mailing Address - Fax:281-419-5885
Practice Address - Street 1:25440 I-45 NORTH
Practice Address - Street 2:SUITE 300
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77386-1343
Practice Address - Country:US
Practice Address - Phone:281-419-1599
Practice Address - Fax:281-419-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8071246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty