Provider Demographics
NPI:1366541922
Name:BELLAIRE DIAGNOSTIC IMAGING, LLC
Entity type:Organization
Organization Name:BELLAIRE DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-239-8538
Mailing Address - Street 1:9440 BELLAIRE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4558
Mailing Address - Country:US
Mailing Address - Phone:832-239-8538
Mailing Address - Fax:713-772-8032
Practice Address - Street 1:9440 BELLAIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4558
Practice Address - Country:US
Practice Address - Phone:832-239-8538
Practice Address - Fax:713-772-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180264701Medicaid
TX180264701Medicaid
TX00538YMedicare PIN