MEDICARE: SAFEWAY IMAGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1043638109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFEWAY IMAGING LLC

Provider Business Mailing Address
First Line	:	PO BOX 2064
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-9064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3270 SOUTH LOOP W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-5201
Country	:	US
Telephone Number	:	281-208-3344
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ZESHAN KASSAM
Credential	:
Telephone Number	:	281-208-3344

Provider Enumeration Date	:	04/04/2014
Last Update Date	:	04/04/2014

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Directions to “SAFEWAY IMAGING LLC ” Practice Location

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