MEDICARE: PATIENTCARE DIAGNOSTIC SERVICES

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1730508219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATIENTCARE DIAGNOSTIC SERVICES

Provider Business Mailing Address
First Line	:	10998 S WILCREST DR STE 272
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-3596
Country	:	US
Telephone Number	:	832-657-5301
Fax Number	:	713-234-7936

Provider Business Practice Location Address
First Line	:	10998 S WILCREST DR STE 272
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-3596
Country	:	US
Telephone Number	:	832-657-5301
Fax Number	:	713-234-7936

Authorized Official
Title or Position	:	CEO
Name	:	ROBERTO ZAMORA
Credential	:
Telephone Number	:	832-657-5301

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	04/10/2014

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