Provider Demographics
NPI:1881492106
Name:NEBULA IMAGING CENTER LLC
Entity type:Organization
Organization Name:NEBULA IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAULIK
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-687-8393
Mailing Address - Street 1:PO BOX 580526
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77258-0526
Mailing Address - Country:US
Mailing Address - Phone:678-687-7494
Mailing Address - Fax:281-837-7573
Practice Address - Street 1:910 N HIGHWAY 146 FRONTAGE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77258-0526
Practice Address - Country:US
Practice Address - Phone:678-687-7494
Practice Address - Fax:281-837-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology