MEDICARE: BELLAIRE DIAGNOSTIC IMAGING, 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	2085R0202X	Diagnostic Radiology Physician
2	261QR0200X	Radiology Clinic/Center

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

General Provider Information

NPI Number	:	1366541922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLAIRE DIAGNOSTIC IMAGING, LLC

Provider Business Mailing Address
First Line	:	9440 BELLAIRE BLVD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-4558
Country	:	US
Telephone Number	:	832-239-8538
Fax Number	:	713-772-8032

Provider Business Practice Location Address
First Line	:	9440 BELLAIRE BLVD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-4558
Country	:	US
Telephone Number	:	832-239-8538
Fax Number	:	713-772-8032

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN LEE
Credential	:	M.D.
Telephone Number	:	832-239-8538

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	12/12/2023

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