# EASTLAKE RADIOLOGY LLC

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

## Provider details

- **NPI number:** 1346427291
- **Authorized official:** MR. STEPHEN VOGELPOHL (CEO)
- **Authorized official phone:** (512) 585-6265

## Contact information

- **Practice address:** 11605 FM 1960 E, HUFFMAN, TX 77336
- **Practice address phone:** (877) 839-9517
- **Mailing address:** 11605 FM 1960 E, HUFFMAN, TX 77336

## Taxonomy

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

## Other

- **Enumeration date:** 01/23/2008
- **Last updated:** 06/15/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0678DC | BCBS OF TEXAS | TX |
| 01 | — | P00699983 | RAILROAD MEDICARE | — |