Basic Information
| Provider Information | |||||||||
| NPI: | 1356389605 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST HOUSTON RADIOLOGY ASSOCIATES LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MACARTHUR PL STE 300 | ||||||||
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| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927077726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134417558 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21214 NORTHWEST FWY | ||||||||
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| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814557618 | ||||||||
| FaxNumber: | 2817812003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | SCANLON | ||||||||
| AuthorizedOfficialFirstName: | KEEGAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3033780128 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 083255201 | 05 | TX | MEDICAID |