MEDICARE: IMAGE AMERICA DIAGNOSTIC IMAGING CENTER, LTD

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	:	1770695819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGE AMERICA DIAGNOSTIC IMAGING CENTER, LTD

Provider Business Mailing Address
First Line	:	3391 WESTPARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-4262
Country	:	US
Telephone Number	:	713-660-8383
Fax Number	:	713-663-6262

Provider Business Practice Location Address
First Line	:	3391 WESTPARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-4262
Country	:	US
Telephone Number	:	713-660-8383
Fax Number	:	713-663-6262

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRIAN DAVID MOBLEY
Credential	:
Telephone Number	:	713-660-8383

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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