MEDICARE: CASPIAN 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	P3396	TX

General Provider Information

NPI Number	:	1619358066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASPIAN DIAGNOSTIC IMAGING LLC

Provider Business Mailing Address
First Line	:	8300 BISSONNET ST STE 120
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-3911
Country	:	US
Telephone Number	:	832-899-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 BISSONNET ST STE 120
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-3911
Country	:	US
Telephone Number	:	832-899-4222
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RAMIN MAMMADOV
Credential	:
Telephone Number	:	832-899-4222

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	06/11/2015

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