Organization
MEMORIAL MRI & DIAGNOSTIC, LLC
Active
Other names
Memorial Nuclear Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
JORRIE FATHEREE (MANAGER)
(713) 461-3399
Entity
Organization
Contact information
Practice address
8800 KATY FWY STE 105, HOUSTON, TX 77024-1645
(713) 461-3399
(713) 461-1969
Mailing address
PO BOX 802185, HOUSTON, TX 77280-2185
(713) 461-3399
(713) 461-1969
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
L05997
TX
207UN0901X
Nuclear Cardiology Physician
L05997
TX
207UN0902X
Nuclear Imaging & Therapy Physician
L05997
TX
207UN0903X
In Vivo & In Vitro Nuclear Medicine Physician
L05997
TX
2085N0904X
Nuclear Radiology Physician
Primary
L05997
TX
2085R0202X
Diagnostic Radiology Physician
L05997
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0203DC
BLUE CROSS, BLUE SHIELD
TX
05
—
153985002
—
TX
Enumeration date
09/28/2006
Last updated
07/26/2019
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