Provider Demographics
NPI:1366423790
Name:CONROE TOMBALL RADIOLOGISTS PA
Entity type:Organization
Organization Name:CONROE TOMBALL RADIOLOGISTS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALSARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-359-7788
Mailing Address - Street 1:800 ROCKMEAD DR
Mailing Address - Street 2:S:210
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2112
Mailing Address - Country:US
Mailing Address - Phone:281-359-7788
Mailing Address - Fax:281-359-7888
Practice Address - Street 1:9250 PINECROFT DR
Practice Address - Street 2:
Practice Address - City:WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77387
Practice Address - Country:US
Practice Address - Phone:281-359-7788
Practice Address - Fax:281-359-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127270003Medicaid
TX127270001Medicaid
C50133Medicare PIN
00LK23Medicare PIN
00753NMedicare PIN
CG6456Medicare PIN