Provider Demographics
NPI:1902108574
Name:CONROE PREMIER IMAGING CENTER LP
Entity Type:Organization
Organization Name:CONROE PREMIER IMAGING CENTER LP
Other - Org Name:CONROE PREMIER IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIPPRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-991-1007
Mailing Address - Street 1:111 VISION PARK BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3002
Mailing Address - Country:US
Mailing Address - Phone:361-991-1007
Mailing Address - Fax:361-991-2031
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:361-991-1007
Practice Address - Fax:361-991-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology