Healthcare Provider Details

I. General information

NPI: 1497403976
Provider Name (Legal Business Name): NORTHEAST IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22751 PROFESSIONAL DR
KINGWOOD TX
77339-6021
US

IV. Provider business mailing address

22751 PROFESSIONAL DR
KINGWOOD TX
77339-6021
US

V. Phone/Fax

Practice location:
  • Phone: 832-882-6742
  • Fax: 281-664-5899
Mailing address:
  • Phone: 832-882-6742
  • Fax: 281-664-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RAHUL DHAWAN
Title or Position: CEO
Credential:
Phone: 832-882-6742