MEDICARE: PINK DOOR IMAGING CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0206X	Mammography Clinic/Center

General Provider Information

NPI Number	:	1114374931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINK DOOR IMAGING CENTER LLC

Provider Business Mailing Address
First Line	:	2424 W HOLCOMBE BLVD STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1933
Country	:	US
Telephone Number	:	832-804-8119
Fax Number	:	832-804-8120

Provider Business Practice Location Address
First Line	:	2424 W HOLCOMBE BLVD STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1933
Country	:	US
Telephone Number	:	832-804-8119
Fax Number	:	832-804-8120

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAHESH K SHETTY
Credential	:	MD
Telephone Number	:	713-899-3797

Provider Enumeration Date	:	05/22/2016
Last Update Date	:	05/22/2016

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Directions to “PINK DOOR IMAGING CENTER LLC ” Practice Location

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