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General NPI Number Information
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NPI Number | 1255440046
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Entity Type | Organization
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Legal Business Name | CONCEPT PHOENIX
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1336 PIN OAK RD
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City | KATY
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State | TX
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Zip | 77494-6849
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Country | US
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Telephone | 281-394-1300
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Fax | 281-394-1301
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Provider Business Mailing Address
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Address Line | 1336 PIN OAK RD
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City | KATY
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State | TX
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Zip | 77494-6849
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Country | US
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Telephone | 281-394-1300
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Fax | 281-394-1301
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. PHILIP JEFFERSON WEAVER
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Credential | M.D.
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Telephone | 281-394-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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