| Organization Name: | PENN IMAGING OF HUMBLE, LP |
| NPI Number: | 1215039367 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GRACIE DE LEON (ADMINISTRATOR) |
| Mailing Address: | 9802 Fm 1960 Bypass Rd W Ste 100 Humble |
| State: | TX US |
| Postal Code: | 773383572 |
| Phone Number: | 2813583800 |
| Fax Number: | 2813583910 |
| NPI Enumeration Date: | 09/01/2006 |
| NPI Last Update Date: | 02/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 293D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Laboratories |
| Taxonomy Classification: | Physiological Laboratory |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A laboratory that operates independently of a hospital and physician |