Provider Demographics
NPI:1053697466
Name:SURGI-RAD TECHNOLOGIES, LLC
Entity type:Organization
Organization Name:SURGI-RAD TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRIOTT-EMFINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:936-494-8266
Mailing Address - Street 1:PO BOX 8556
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77387-8556
Mailing Address - Country:US
Mailing Address - Phone:936-494-8266
Mailing Address - Fax:936-582-4445
Practice Address - Street 1:18989 HARBOR SIDE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-3224
Practice Address - Country:US
Practice Address - Phone:936-494-8266
Practice Address - Fax:936-582-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-30
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00358174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty