Provider Demographics
NPI:1992456602
Name:ROCKET RADIOLOGY, LLC
Entity type:Organization
Organization Name:ROCKET RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:WINFREE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)(CT)(ARRT)
Authorized Official - Phone:281-299-6189
Mailing Address - Street 1:825 WATTER'S CREEK BLVD.250-#3356
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:281-299-6189
Mailing Address - Fax:
Practice Address - Street 1:825 WATTER'S CREEK BLVD.250-#3356
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:281-299-6189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile