MEDICARE: RAYTEL NUCLEAR IMAGING - WEST HOUSTON, INC.

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	261QM2500X	Medical Specialty Clinic/Center	L04882	TX

General Provider Information

NPI Number	:	1881649622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYTEL NUCLEAR IMAGING - WEST HOUSTON, INC.

Provider Business Mailing Address
First Line	:	7 WATERSIDE XING
Second Line	:	3RD FLOOR ATTN: KAREN FRISK, CONTRACTING
City	:	WINDSOR
State	:	CT
Zip	:	06095-1540
Country	:	US
Telephone Number	:	800-367-1095
Fax Number	:	860-298-6127

Provider Business Practice Location Address
First Line	:	1416 CAMPBELL RD
Second Line	:	SUITE 101
City	:	HOUSTON
State	:	TX
Zip	:	77055-4604
Country	:	US
Telephone Number	:	713-464-7914
Fax Number	:	713-464-8270

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFFREY M FLANEGIN
Credential	:
Telephone Number	:	610-831-1112

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	08/31/2007

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