Provider Demographics
NPI:1770953408
Name:ALLIANCE MRI LAKE HOUSTON, LLC
Entity type:Organization
Organization Name:ALLIANCE MRI LAKE HOUSTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-773-2018
Mailing Address - Street 1:5514 ATASCOCITA ROAD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346
Mailing Address - Country:US
Mailing Address - Phone:832-644-0148
Mailing Address - Fax:832-924-7962
Practice Address - Street 1:5514 ATASCOCITA ROAD
Practice Address - Street 2:SUITE 180
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346
Practice Address - Country:US
Practice Address - Phone:713-468-3842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0200X
TX261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology