| Pearland Diagnostic Clinic, Pa | |
|
1834 Broadway St Suite 102 Pearland TX 77581-5668 | |
| (281) 997-8181 | |
| (281) 997-8184 |
| Full Name | Pearland Diagnostic Clinic, Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 1834 Broadway St, Pearland, Texas |
| Authorized Official Name and Position | Joseph H Roosth (OWNER) |
| Authorized Official Contact | 2819978181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pearland Diagnostic Clinic, Pa 1834 Broadway St Suite 102 Pearland TX 77581-5668 Ph: (281) 997-8181 | Pearland Diagnostic Clinic, Pa 1834 Broadway St Suite 102 Pearland TX 77581-5668 Ph: (281) 997-8181 |
| NPI Number | 1194970756 |
|---|---|
| Provider Enumeration Date | 11/24/2008 |
| Last Update Date | 06/19/2012 |
| Medicare PECOS PAC ID | 8224164728 |
|---|---|
| Medicare Enrollment ID | O20100408000323 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194970756 | NPI | - | NPPES |
| 128481204 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MDH7345 (Texas) | Primary |
| Provider Name | Joseph Howard Roosth |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851308787 PECOS PAC ID: 7719016005 Enrollment ID: I20100525000646 |
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