Eastlake Radiology LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

EASTLAKE RADIOLOGY LLC

Practice address

11605 FM 1960 E
Huffman, TX 77336

Phone

(877) 839-9517

NPI assigned

Jan 23, 2008

Last updated

Jun 15, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Stephen Vogelpohl

Title

Ceo

Phone

(512) 585-6265

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245024000000",
    "number": "1346427291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11605 FM 1960 E",
            "city": "HUFFMAN",
            "state": "TX",
            "postal_code": "77336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11605 FM 1960 E",
            "city": "HUFFMAN",
            "state": "TX",
            "postal_code": "77336",
            "telephone_number": "877-839-9517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAKE RADIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-23",
        "last_updated": "2009-06-15",
        "status": "A",
        "authorized_official_last_name": "VOGELPOHL",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-585-6265",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00699983",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "0678DC",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Radiology Clinic/Center in Huffman, TX
• Providers in Huffman, TX by specialty
• Radiology Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.