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 8/13/2012.

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 43551882 MEDICAID NM
2 400521206 MEDICARE ID-TYPE UNSPECIFIED
3 NMA100416 OTHER NM MEDICARE

NPI Record

No. Field Name Field Value
1 NPI 1700852373
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name ALAMOGORDO IMAGING CENTER LLC
5 Provider First Line Business Practice Location Address 2539 MEDICAL DR
6 Provider Second Line Business Practice Location Address STE 101
7 Provider Business Practice Location Address City Name ALAMOGORDO
8 Provider Business Practice Location Address State Name NM
9 Provider Business Practice Location Address Postal Code 88310
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 5054341353
12 Provider Business Practice Location Address Fax Number 5054341398
13 Provider Enumeration Date 2/24/2006
14 Last Update Date 8/13/2012
15 Authorized Official Last Name BRANDT
16 Authorized Official First Name SAMUEL
17 Authorized Official Middle Name J.
18 Authorized Official Title or Position VP/CFO
19 Authorized Official Telephone Number 5059983096
20 Healthcare Provider Taxonomy Code 1 2085R0202X
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 43551882
23 Other Provider Identifier Type Code 1 05
24 Other Provider Identifier State 1 NM
25 Other Provider Identifier 2 400521206
26 Other Provider Identifier Type Code 2 04
27 Other Provider Identifier 3 NMA100416
28 Other Provider Identifier Type Code 3 01
29 Other Provider Identifier State 3 NM
30 Other Provider Identifier Issuer 3 MEDICARE
31 Is Organization Subpart N
32 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 8/12/2014
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