=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841855020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPRAD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2019
-----------------------------------------------------
Last Update Date | 07/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20910 ATASCOCITA POINT DR
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77346-1648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-984-0688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9802 FM 1960 BYPASS RD W STE 100
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77338-3572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-358-3800
-----------------------------------------------------
Fax | 281-358-3910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RADIOLOGIST
-----------------------------------------------------
Name | DR. ADAM MYERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-358-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------