Provider Demographics
NPI:1932634169
Name:3083 IMAGING LLC
Entity Type:Organization
Organization Name:3083 IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCKAY SMART
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-922-6718
Mailing Address - Street 1:2257 N LOOP 336 W # 140368
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3566
Mailing Address - Country:US
Mailing Address - Phone:713-922-6718
Mailing Address - Fax:
Practice Address - Street 1:1246 N FM 3083 WEST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:713-922-6718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology