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General NPI Number Information
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NPI Number | 1184806143
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Entity Type | Organization
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Legal Business Name | MANASSEH MEDICAL IMAGING, INC
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 4311 IRONTON AVE #2
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City | LUBBOCK
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State | TX
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Zip | 79407-3735
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Country | US
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Telephone | 806-239-0509
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16856
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City | LUBBOCK
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State | TX
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Zip | 79490-6856
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Country | US
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Telephone | 806-771-1386
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LARRY ROSALES
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Credential | RT(ARRT)
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Telephone | 806-239-0509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | FTUVC9
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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