ALAMOGORDO IMAGING CENTER LLC - NPI NUMBER 1700852373

Summary

Provider Name: ALAMOGORDO IMAGING CENTER LLC

NPI Number: 1700852373

Clasification: Radiology (2085R0202X)

Specialization: Diagnostic Radiology

Address:
2539 MEDICAL DR
STE 101
ALAMOGORDO, NM
ZIP 88310

Phone Number: (505) 434-1353



Detailed Information

ALAMOGORDO IMAGING CENTER LLC is a diagnostic radiology radiologist in Alamogordo, NM. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. The assigned NPI number for this provider is 1700852373 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

2539 MEDICAL DR
STE 101
ALAMOGORDO, NM
ZIP 88310
Phone: (505) 434-1353
Fax: (505) 434-1398

The provider's authorized official is Samuel J. Brandt .
The authorized official title is Vp/cfo and has the following contact phone number (505) 998-3096.

The enumeration date for this NPI number is 2/24/2006 and was last updated on 9/22/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 2085R0202X Radiology Diagnostic Radiology Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 NMA100416 OTHER NM MEDICARE
2 43551882 MEDICAID NM

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1700852373 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name ALAMOGORDO IMAGING CENTER LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 2539 MEDICAL DR The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address STE 101 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name ALAMOGORDO The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name NM The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 88310 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 5054341353 The telephone number associated with the location address of the provider being identified.
12 Provider Business Practice Location Address Fax Number 5054341398 The fax number associated with the location address of the provider being identified.
13 Provider Enumeration Date 2/24/2006 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 9/22/2014 The date that a record was last updated or changed.
15 Authorized Official Last Name BRANDT The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name SAMUEL The first name of the authorized official.
17 Authorized Official Middle Name J. The middle name of the authorized official.
18 Authorized Official Title or Position VP/CFO The title or position of the authorized official.
19 Authorized Official Telephone Number 5059983096 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 2085R0202X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 NMA100416 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier Type Code 1 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier State 1 NM
25 Other Provider Identifier Issuer 1 MEDICARE
26 Other Provider Identifier 2 43551882 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier State 2 NM
29 Is Organization Subpart N
30 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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