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General NPI Number Information
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NPI Number | 1659622629
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Entity Type | Organization
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Legal Business Name | VILLAGE DIAGNOSTIC CLINIC, INC.
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Dates
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Enumeration Date | 09/30/2012
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Last Update Date | 09/30/2012
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Provider Practice Location Address
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Address Line | 10101 HARWIN DR SUITE # 194
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City | HOUSTON
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State | TX
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Zip | 77036-1687
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Country | US
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Telephone | 832-830-8574
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Fax | 832-830-8659
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Provider Business Mailing Address
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Address Line | 10101 HARWIN DR SUITE # 194
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City | HOUSTON
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State | TX
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Zip | 77036-1687
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Country | US
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Telephone | 832-830-8574
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Fax | 832-830-8659
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROMAN G. SHAKHMANOV
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Credential |
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Telephone | 832-830-8574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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