Healthcare Provider Details

I. General information

NPI: 1174037287
Provider Name (Legal Business Name): GILEAD IMAGE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 N JACKSON RD
PHEER TX
78577
US

IV. Provider business mailing address

PO. BOX 2 5500 N RD
MCALLEN TX
78504
US

V. Phone/Fax

Practice location:
  • Phone: 718-740-2344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANTY THOMAS
Title or Position: SONOGRAPHER
Credential: ARDMS
Phone: 956-551-8840