MEDICARE: CHOPRA IMAGING CENTERS, INC.

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	261QR0200X	Radiology Clinic/Center	R25124	TX
2	207U00000X	Nuclear Medicine Physician	L05566	TX

General Provider Information

NPI Number	:	1144263849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOPRA IMAGING CENTERS, INC.

Provider Business Mailing Address
First Line	:	1911 BAGBY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-8594
Country	:	US
Telephone Number	:	713-383-7147
Fax Number	:	713-383-1302

Provider Business Practice Location Address
First Line	:	4200 TWELVE OAKS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6812
Country	:	US
Telephone Number	:	713-790-1666
Fax Number	:	713-383-1302

Authorized Official
Title or Position	:	VP REVENUE CYCLE MANAGEMENT
Name	:	LANISA GUIDRY
Credential	:
Telephone Number	:	713-795-1107

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/07/2021

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