Provider Demographics
NPI:1912118795
Name:I-IMAGING
Entity type:Organization
Organization Name:I-IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TROCKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-453-7917
Mailing Address - Street 1:20320 NORTHWEST FWY STE 900
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5620
Mailing Address - Country:US
Mailing Address - Phone:281-453-7916
Mailing Address - Fax:832-381-3801
Practice Address - Street 1:8850 SIX PINES DRIVE
Practice Address - Street 2:SUITE 190
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:832-381-3800
Practice Address - Fax:832-381-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN
TX00Z979Medicare PIN