Healthcare Provider Details

I. General information

NPI: 1700852373
Provider Name (Legal Business Name): ALAMOGORDO IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 MEDICAL DR STE 101
ALAMOGORDO NM
88310
US

IV. Provider business mailing address

8020 CONSTITUTION PLACE NE #202
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-434-1353
  • Fax: 505-434-1398
Mailing address:
  • Phone: 505-998-3096
  • Fax: 505-998-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL J. BRANDT
Title or Position: VP/CFO
Credential:
Phone: 505-998-3096