MEDICARE: TRIMED MANAGEMENT SERVICES 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

General Provider Information

NPI Number	:	1306095773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIMED MANAGEMENT SERVICES LLC

Provider Business Mailing Address
First Line	:	957 NASA PKWY # 513
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3039
Country	:	US
Telephone Number	:	832-425-9448
Fax Number	:

Provider Business Practice Location Address
First Line	:	957 NASA PKWY # 513
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3039
Country	:	US
Telephone Number	:	832-425-9448
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SYLVIA SURBER
Credential	:
Telephone Number	:	832-425-9448

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/10/2008

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