Provider Demographics
NPI:1386422293
Name:SOUTH HAMPTON MEDICAL IMAGING, LLC
Entity type:Organization
Organization Name:SOUTH HAMPTON MEDICAL IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SASAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-202-8176
Mailing Address - Street 1:13012 SHALLOW FALLS LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-6524
Mailing Address - Country:US
Mailing Address - Phone:832-202-8176
Mailing Address - Fax:
Practice Address - Street 1:7707 FANNIN ST STE 159
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1918
Practice Address - Country:US
Practice Address - Phone:832-202-8176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty