=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184411258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMESCAN HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2025
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7621 SOMMERVILLE PLACE RD
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76135-4225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-291-7788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7621 SOMMERVILLE PLACE RD
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76135-4225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-291-7788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | GEORGE ESCOBAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 707-291-7788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------