Provider Demographics
NPI:1982697462
Name:FOUNDATION IMAGING AFFILIATES OF HUNTSVILLE LLP
Entity Type:Organization
Organization Name:FOUNDATION IMAGING AFFILIATES OF HUNTSVILLE LLP
Other - Org Name:HUNTSVILLE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GOVERNING BOARD CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-730-1000
Mailing Address - Street 1:643A IH 45 S
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-6434
Mailing Address - Country:US
Mailing Address - Phone:936-730-1000
Mailing Address - Fax:936-730-1010
Practice Address - Street 1:643A IH 45 S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-6434
Practice Address - Country:US
Practice Address - Phone:936-730-1000
Practice Address - Fax:936-730-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR26934261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTVUX5Medicare ID - Type Unspecified