MEDICARE: ALLIED DIAGNOSTICS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0064ML	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1790817435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED DIAGNOSTICS

Provider Business Mailing Address
First Line	:	565 S MASON RD
Second Line	:	#397
City	:	KATY
State	:	TX
Zip	:	77450-2437
Country	:	US
Telephone Number	:	281-395-4121
Fax Number	:	281-395-6315

Provider Business Practice Location Address
First Line	:	1820 S MASON RD # 330
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-6148
Country	:	US
Telephone Number	:	281-395-4121
Fax Number	:	281-395-6315

Authorized Official
Title or Position	:	V.P. OF OPERATIONS
Name	:	MRS. SHARON MARTIN
Credential	:
Telephone Number	:	281-395-4121

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	03/19/2010

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Directions to “ALLIED DIAGNOSTICS ” Practice Location

Language	Start Address	Practice Location

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