Basic Information
| Provider Information | |||||||||
| NPI: | 1508298126 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNERGY RADIOLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7026 OLD KATY RD | ||||||||
| Address2: | STE 276 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136217436 | ||||||||
| FaxNumber: | 7139639051 | ||||||||
| Practice Location | |||||||||
| Address1: | 7026 OLD KATY RD | ||||||||
| Address2: | STE 276 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136217436 | ||||||||
| FaxNumber: | 7139639051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2013 | ||||||||
| LastUpdateDate: | 08/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | WHITTEN | ||||||||
| AuthorizedOfficialFirstName: | LIA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE/OPERATIONS SPECIALIS | ||||||||
| AuthorizedOfficialTelephone: | 7136217436 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 243U00000X | 12TX1463 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiology Practitioner Assistant |
No ID Information.