MEDICARE: PALLA RPS 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	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1700158656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALLA RPS LLC

Provider Business Mailing Address
First Line	:	6410 VIRGINIA FIELDS DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0329
Country	:	US
Telephone Number	:	281-394-2897
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 VIRGINIA FIELDS DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0329
Country	:	US
Telephone Number	:	281-394-2897
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	PRASANNA K PALLA
Credential	:
Telephone Number	:	281-394-2897

Provider Enumeration Date	:	02/07/2012
Last Update Date	:	02/07/2012

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