MEDICARE: NEBULA IMAGING CENTER 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1881492106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEBULA IMAGING CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 580526
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77258-0526
Country	:	US
Telephone Number	:	678-687-7494
Fax Number	:	281-837-7573

Provider Business Practice Location Address
First Line	:	910 N HIGHWAY 146 FRONTAGE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77258-0526
Country	:	US
Telephone Number	:	678-687-7494
Fax Number	:	281-837-7573

Authorized Official
Title or Position	:	CEO
Name	:	MAULIK PANCHOLI
Credential	:
Telephone Number	:	678-687-8393

Provider Enumeration Date	:	03/04/2025
Last Update Date	:	03/04/2025

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Directions to “NEBULA IMAGING CENTER LLC ” Practice Location

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