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General NPI Number Information
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NPI Number | 1093127516
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Entity Type | Organization
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Legal Business Name | AIRLINE DIAGNOSIS CENTER LLC
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 5990 AIRLINE DR 130A
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City | HOUSTON
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State | TX
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Zip | 77076-4233
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Country | US
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Telephone | 713-884-8070
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Fax | 713-884-8077
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Provider Business Mailing Address
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Address Line | 5200 MITCHELLDALE ST F-27
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City | HOUSTON
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State | TX
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Zip | 77092-7206
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Country | US
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Telephone | 832-878-2048
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Fax | 713-956-2555
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | MR. GHOLAMHOSSEIN OMIDI
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Credential |
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Telephone | 832-878-2048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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