MEDICARE: ORIGIN DIAGNOSTICS 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1497638894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORIGIN DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	9135 KATY FWY STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1636
Country	:	US
Telephone Number	:	832-429-2216
Fax Number	:

Provider Business Practice Location Address
First Line	:	19610 TOMBALL PKWY STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-6170
Country	:	US
Telephone Number	:	281-899-0019
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALI MAZLOOM
Credential	:
Telephone Number	:	832-429-2216

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	08/08/2025

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Directions to “ORIGIN DIAGNOSTICS LLC ” Practice Location

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