Provider Demographics
NPI:1902302193
Name:AMD HEALTHCARE LC, LLC
Entity Type:Organization
Organization Name:AMD HEALTHCARE LC, LLC
Other - Org Name:AVAIL LC RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARROCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-590-0640
Mailing Address - Street 1:9811 KATY FWY STE 1060
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1280
Mailing Address - Country:US
Mailing Address - Phone:713-590-0640
Mailing Address - Fax:
Practice Address - Street 1:3730 NELSON ROAD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-513-0817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMD HEALTHCARE LC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty