MEDICARE: PROFESSIONAL IMAGAING, 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1174717334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL IMAGAING, LLC

Provider Business Mailing Address
First Line	:	507 N SAM HOUSTON PKWY E
Second Line	:	SUITE 245
City	:	HOUSTON
State	:	TX
Zip	:	77060-4021
Country	:	US
Telephone Number	:	281-272-6277
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 N SAM HOUSTON PKWY E
Second Line	:	SUITE 245
City	:	HOUSTON
State	:	TX
Zip	:	77060-4021
Country	:	US
Telephone Number	:	281-272-6277
Fax Number	:

Authorized Official
Title or Position	:	TREASURER/BOM
Name	:	MR. BEN L BAUMER
Credential	:
Telephone Number	:	805-275-1834

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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Directions to “PROFESSIONAL IMAGAING, LLC ” Practice Location

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