Provider Demographics
NPI:1457882326
Name:SHADOW CREEK IMAGING & DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SHADOW CREEK IMAGING & DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KALPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-210-9332
Mailing Address - Street 1:11711 SHADOW CREEK PKWY
Mailing Address - Street 2:SUITE 147
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7232
Mailing Address - Country:US
Mailing Address - Phone:713-859-9985
Mailing Address - Fax:
Practice Address - Street 1:11711 SHADOW CREEK PKWY
Practice Address - Street 2:SUITE 147
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7232
Practice Address - Country:US
Practice Address - Phone:713-859-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology