MEDICARE: THE BREAST AND IMAGING CENTER, 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	174400000X	Specialist
2	261QR0206X	Mammography Clinic/Center

General Provider Information

NPI Number	:	1396140588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BREAST AND IMAGING CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3140
Second Line	:	DEPT 900
City	:	HOUSTON
State	:	TX
Zip	:	77253-3140
Country	:	US
Telephone Number	:	713-512-7027
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 FANNIN ST STE 1500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2950
Country	:	US
Telephone Number	:	713-512-7655
Fax Number	:	713-512-7082

Authorized Official
Title or Position	:	VP, PRACTICE OPERATIONS
Name	:	EVAN VARADI
Credential	:
Telephone Number	:	713-825-0028

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	06/14/2024

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