Healthcare Provider Details

I. General information

NPI: 1528376340
Provider Name (Legal Business Name): IME PLUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 HANCOCK CT NE SUITE D
ALBUQUERQUE NM
87109-4591
US

IV. Provider business mailing address

7400 HANCOCK CT NE SUITE D
ALBUQUERQUE NM
87109-4591
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-9100
  • Fax:
Mailing address:
  • Phone: 505-821-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MS. TTRICIA A FULLERTON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 505-821-9100