MEDICARE: RAYFORD DIAGNOSTIC LEASING 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	246Z00000X	Other Specialist/Technologist	H8071	TX

General Provider Information

NPI Number	:	1336419589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYFORD DIAGNOSTIC LEASING LLC

Provider Business Mailing Address
First Line	:	25440 I-45 NORTH
Second Line	:	SUITE 300
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1343
Country	:	US
Telephone Number	:	281-419-1599
Fax Number	:	281-419-5885

Provider Business Practice Location Address
First Line	:	25440 I-45 NORTH
Second Line	:	SUITE 300
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1343
Country	:	US
Telephone Number	:	281-419-1599
Fax Number	:	281-419-5885

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. FADI G GHANEM
Credential	:	MD
Telephone Number	:	281-419-1599

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/05/2012

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