MEDICARE: DM 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	261Q00000X	Clinic/Center
2	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q8695	OTHER	TX	DIAGNOSTIC RADIOLOGY

General Provider Information

NPI Number	:	1841765443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DM MEDICAL IMAGING LLC

Provider Business Mailing Address
First Line	:	9606 BEVLYN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-4502
Country	:	US
Telephone Number	:	346-971-2249
Fax Number	:

Provider Business Practice Location Address
First Line	:	10021 MAIN ST STE B1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-5253
Country	:	US
Telephone Number	:	346-971-2249
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. XIUMIN DI
Credential	:
Telephone Number	:	346-971-2249

Provider Enumeration Date	:	10/10/2018
Last Update Date	:	02/04/2019

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Directions to “DM MEDICAL IMAGING LLC ” Practice Location

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