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NPI Code Detail

MEDICARE: NORTHWEST DIAGNOSTIC CLINIC, PA

MEDICARE: NORTHWEST DIAGNOSTIC CLINIC, PA
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
1207R00000XInternal Medicine PhysicianTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
200T359OTHERTXBCBS OF TX GROUP #

General Provider Information

NPI Number : 1417952094
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST DIAGNOSTIC CLINIC, PA
Provider Business Mailing Address
First Line : 2255 E MOSSY OAKS RD STE 500
Second Line :
City : SPRING
State : TX
Zip : 77389-1813
Country : US
Telephone Number : 281-440-5300
Fax Number : 832-232-5591
Provider Business Practice Location Address
First Line : 2255 E MOSSY OAKS RD STE 500
Second Line :
City : SPRING
State : TX
Zip : 77389-1813
Country : US
Telephone Number : 281-440-5300
Fax Number : 832-232-5591
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MR. STEPHEN D FILLMAN
Credential : MD
Telephone Number : 281-440-5300
Provider Enumeration Date : 06/20/2005
Last Update Date : 07/21/2022

Similar Medicare Providers

1447224225 — JAMES M KRAUSE M.D.
Practice Location Address:
2255 E MOSSY OAKS RD STE 500
SPRING, TX
77389-1813
Practice Phone: 281-440-5300
Practice Fax: 832-232-5591
1700832672 — NORTHWEST DIAGNOSTIC CLINIC, PA
Practice Location Address:
2255 E MOSSY OAKS RD STE 500
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Practice Fax: 832-232-5591
1427250349 — DR. AMIE MAO SUN-WRIGHT MD
Practice Location Address:
2255 E MOSSY OAKS RD STE 500
SPRING, TX
77389-1813
Practice Phone: 281-440-5300
Practice Fax: 832-232-5591
1700047412 — DR. SAMER M ELFALLAL D.O.
Practice Location Address:
2255 E MOSSY OAKS RD STE 500
SPRING, TX
77389-1813
Practice Phone: 281-440-5300
Practice Fax:
1821223645 — DR. JUSTIN GYORFI M.D.
Practice Location Address:
2255 E MOSSY OAKS RD STE 500
SPRING, TX
77389-1813
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Practice Fax:
1386875698 — DR. JILU J. VARGHESE M.D
Practice Location Address:
2255 E MOSSY OAKS RD STE 500
SPRING, TX
77389-1813
Practice Phone: 281-440-5300
Practice Fax: 832-232-5591

Directions to “NORTHWEST DIAGNOSTIC CLINIC, PA ” Practice Location

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