=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568400810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INNOVATIVE RADIOLOGY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3310 RICHMOND AVE
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77098-3008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-797-1919
-----------------------------------------------------
Fax | 713-383-9933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4346 DEPT 486
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77210-4346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-797-1919
-----------------------------------------------------
Fax | 713-383-9983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RANDALL STENOIEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-526-5771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------