Provider Demographics
NPI:1356711154
Name:INTEGRATED DIAGNOSTIC CENTER, INC.
Entity type:Organization
Organization Name:INTEGRATED DIAGNOSTIC CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-290-2113
Mailing Address - Street 1:11811 NORTH FWY
Mailing Address - Street 2:# 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3245
Mailing Address - Country:US
Mailing Address - Phone:713-290-2200
Mailing Address - Fax:
Practice Address - Street 1:11811 NORTH FWY
Practice Address - Street 2:# 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3245
Practice Address - Country:US
Practice Address - Phone:713-290-2201
Practice Address - Fax:713-290-2201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGY FACILITIES CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology