MEDICARE: GULF GATE MRI

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	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist

General Provider Information

NPI Number	:	1497281257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF GATE MRI

Provider Business Mailing Address
First Line	:	901 S 75TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-4303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S 75TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-4303
Country	:	US
Telephone Number	:	281-862-8166
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGEGER
Name	:	LAURA GUTIERREZ
Credential	:
Telephone Number	:	281-862-8166

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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