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Organization

PROFESSIONAL IMAGING, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BEN LOUIS BAUMER (ACCOUNT MANAGER)
(281) 272-6277
Entity
Organization

Contact information

Practice address
1717 ROTARY DR, HUMBLE, TX 77338-5235
(866) 676-6277
(281) 272-6281
Mailing address
6078 BRIDGEVIEW DR, VENTURA, CA 93003-1126
(805) 293-1573
(805) 275-1842

Taxonomy

Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
2085R0202X
Diagnostic Radiology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0007115656
AETNA
TX
01
0073ML
BC/BS OF TEXAS
TX
05
172298501
TX
01
DD1023
RAILROAD MEDICARE
TX
Enumeration date
07/02/2006
Last updated
02/06/2023
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