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Organization
EASTLAKE RADIOLOGY LLC
Active
Organization
EASTLAKE RADIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN VOGELPOHL (CEO)
(512) 585-6265
Entity
Organization
Contact information
Practice address
11605 FM 1960 E, HUFFMAN, TX 77336
(877) 839-9517
Mailing address
11605 FM 1960 E, HUFFMAN, TX 77336
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0678DC
BCBS OF TEXAS
TX
01
—
P00699983
RAILROAD MEDICARE
—
Enumeration date
01/23/2008
Last updated
06/15/2009
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