MEDICARE: E PLUS PET IMAGING XXI LP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0493DC	OTHER	TX	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1932152436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E PLUS PET IMAGING XXI LP

Provider Business Mailing Address
First Line	:	13300 HARGRAVE RD
Second Line	:	SUITE 130
City	:	HOUSTON
State	:	TX
Zip	:	77070-4373
Country	:	US
Telephone Number	:	832-327-3900
Fax Number	:	832-327-3902

Provider Business Practice Location Address
First Line	:	13300 HARGRAVE RD
Second Line	:	SUITE 130
City	:	HOUSTON
State	:	TX
Zip	:	77070-4373
Country	:	US
Telephone Number	:	832-327-3900
Fax Number	:	832-327-3902

Authorized Official
Title or Position	:	COO OF GENERAL PARTNER
Name	:	ROBERT RHYMER
Credential	:
Telephone Number	:	615-467-7415

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/16/2010

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