# MANASSEH MEDICAL IMAGING, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184806143
- **Authorized official:** MR. LARRY ROSALES RT(ARRT) (PRESIDENT)
- **Authorized official phone:** (806) 239-0509

## Contact information

- **Practice address:** 4311 IRONTON AVE, \#2, LUBBOCK, TX 79407-3735
- **Practice address phone:** (806) 239-0509
- **Mailing address:** PO BOX 16856, LUBBOCK, TX 79490-6856
- **Mailing address phone:** (806) 771-1386

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 293D00000X | Physiological Laboratory | FTUVC9 | TX | — |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 12/03/2007
- **Last updated:** 04/25/2023