Basic Information
| Provider Information | |||||||||
| NPI: | 1063423382 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STEEPLECHASE DIAGNOSTIC CENTER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AMERICAN HEALTH IMAGING OF STEEPLECHASE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 746530 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303746530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772759077 | ||||||||
| FaxNumber: | 7209740370 | ||||||||
| Practice Location | |||||||||
| Address1: | 11301 FALLBROOK DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770654269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819550440 | ||||||||
| FaxNumber: | 2819559535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 11/05/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LUTZ | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7043625391 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | N | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 293D00000X | N | Laboratories | Physiological Laboratory | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.