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1144872052

NPI Code Detail

MEDICARE: GOLDEN STATE IMAGING ASSOCIATES INC

MEDICARE: GOLDEN STATE IMAGING ASSOCIATES INC

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	2085R0204X	Vascular & Interventional Radiology Physician
2	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144872052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN STATE IMAGING ASSOCIATES INC

Provider Business Mailing Address
First Line	:	PO BOX 85493
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5493
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 ST JOSEPH PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-8301
Country	:	US
Telephone Number	:	888-371-0667
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT, PROVIDER ENROLLMENT
Name	:	KAREN VAUGHN
Credential	:
Telephone Number	:	629-317-1465

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	03/26/2026

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Directions to “GOLDEN STATE IMAGING ASSOCIATES INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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