MEDICARE: EMPIRE DIAGNOSTICS 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	261QR0200X	Radiology Clinic/Center		TX

General Provider Information

NPI Number	:	1285030718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPIRE DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	24 GREENWAY PLZ
Second Line	:	SUITE 1705
City	:	HOUSTON
State	:	TX
Zip	:	77046-2401
Country	:	US
Telephone Number	:	832-649-4363
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 GREENWAY PLZ
Second Line	:	SUITE 1705
City	:	HOUSTON
State	:	TX
Zip	:	77046-2401
Country	:	US
Telephone Number	:	832-649-4363
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	ORLANDO CONCHA
Credential	:
Telephone Number	:	832-420-0688

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	11/11/2014

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