Organization
GREAT LAKES IMAGING S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEEGAN SCANLON (VICE PRESIDENT)
(424) 354-8724
Entity
Organization
Contact information
Practice address
2330 UTAH AVE STE 200, EL SEGUNDO, CA 90245-4817
(424) 290-8004
Mailing address
13333 NORTHWEST FWY STE 540, HOUSTON, TX 77040-6166
(561) 366-2002
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
09/17/2019
Last updated
09/17/2019
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