Basic Information
| Provider Information | |||||||||
| NPI: | 1902802986 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNERGY RADIOLOGY ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7026 OLD KATY RD | ||||||||
| Address2: | SUITE 276 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136217436 | ||||||||
| FaxNumber: | 7139639051 | ||||||||
| Practice Location | |||||||||
| Address1: | 7026 OLD KATY RD | ||||||||
| Address2: | SUITE 276 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136217436 | ||||||||
| FaxNumber: | 7139639051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 11/02/2017 | ||||||||
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| AuthorizedOfficialLastName: | CASTILOW | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINSTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 7133580562 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
ID Information
| ID | Type | State | Issuer | Description | 0831331-01 | 05 | TX | MEDICAID |