=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104040641
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH HOUSTON DIAGNOSTIC CTR PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5990 AIRLINE DR #290
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77076-4233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-694-0357
-----------------------------------------------------
Fax | 713-699-6218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11940
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77293-1940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-694-0357
-----------------------------------------------------
Fax | 713-699-6218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. KOKI SHAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-699-6202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081H0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | G1258
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8130
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------