# CONCEPT PHOENIX

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Radiant Imaging & Diagnostics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255440046
- **Authorized official:** DR. PHILIP JEFFERSON WEAVER M.D. (CHIEF MEDICAL OFFICER)
- **Authorized official phone:** (281) 394-1300

## Contact information

- **Practice address:** 1336 PIN OAK RD, KATY, TX 77494-6849
- **Practice address phone:** (281) 394-1300
- **Practice address fax:** (281) 394-1301
- **Mailing address:** 1336 PIN OAK RD, KATY, TX 77494-6849
- **Mailing address phone:** (281) 394-1300
- **Mailing address fax:** (281) 394-1301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | LO5864 | RAM LICENSE | TX |