MEDICARE: MOUIN CT-MRI

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1902352701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUIN CT-MRI

Provider Business Mailing Address
First Line	:	11375 W SAM HOUSTON PKWY
Second Line	:	150
City	:	HOUSTON
State	:	TX
Zip	:	77031
Country	:	US
Telephone Number	:	281-879-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	11375 W SAM HOUSTON PARKWAY
Second Line	:	150
City	:	HOUSTON
State	:	TX
Zip	:	77031-2347
Country	:	US
Telephone Number	:	281-879-6800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DESPO CALDWELL
Credential	:
Telephone Number	:	713-598-6970

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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