MEDICARE: SOUTH HAMPTON MEDICAL 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1386422293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH HAMPTON MEDICAL IMAGING, LLC

Provider Business Mailing Address
First Line	:	13012 SHALLOW FALLS LN
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-6524
Country	:	US
Telephone Number	:	832-202-8176
Fax Number	:

Provider Business Practice Location Address
First Line	:	7707 FANNIN ST STE 159
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1918
Country	:	US
Telephone Number	:	832-202-8176
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	KRISTINE JILL SASAM
Credential	:
Telephone Number	:	832-202-8176

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/27/2024

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