Healthcare Provider Details

I. General information

NPI: 1376790204
Provider Name (Legal Business Name): IMD HOUSTON GESSNER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 S GESSNER RD SUITE 109
HOUSTON TX
77063-7247
US

IV. Provider business mailing address

3400 S GESSNER RD SUITE 109
HOUSTON TX
77063-7247
US

V. Phone/Fax

Practice location:
  • Phone: 832-242-5400
  • Fax: 832-242-5401
Mailing address:
  • Phone: 832-242-5400
  • Fax: 832-242-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE PAMPELL
Title or Position: IMAGING COORDINATOR
Credential:
Phone: 832-242-5400