MEDICARE: GILEAD IMAGE CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2085P0229X	Pediatric Radiology Physician
2	2085R0202X	Diagnostic Radiology Physician
3	2085B0100X	Body Imaging Physician

General Provider Information

NPI Number	:	1174037287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILEAD IMAGE CENTER

Provider Business Mailing Address
First Line	:	PO. BOX 2 5500 N RD
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3910 N JACKSON RD
Second Line	:
City	:	PHEER
State	:	TX
Zip	:	78577
Country	:	US
Telephone Number	:	718-740-2344
Fax Number	:

Authorized Official
Title or Position	:	SONOGRAPHER
Name	:	MRS. SANTY THOMAS
Credential	:	ARDMS
Telephone Number	:	956-551-8840

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	11/28/2017

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Directions to “GILEAD IMAGE CENTER ” Practice Location

Language	Start Address	Practice Location

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