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General NPI Number Information
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NPI Number | 1508463415
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Entity Type | Organization
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Legal Business Name | CT MEDICAL GROUP
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Dates
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Enumeration Date | 10/04/2020
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Last Update Date | 10/04/2020
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Provider Practice Location Address
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Address Line | 11901 SHADOW CREEK PKWY STE 111B
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City | PEARLAND
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State | TX
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Zip | 77584-7346
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Country | US
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Telephone | 214-435-2374
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 CAVERN DR
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City | MESQUITE
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State | TX
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Zip | 75181-4419
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Country | US
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Telephone | 214-435-2374
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | YAZOMAM IBEKWE
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Credential |
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Telephone | 214-435-2374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging 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 | 2471M1202X
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Taxonomy Name | Magnetic Resonance Imaging Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number |
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License Number State |
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