Healthcare Provider Details

I. General information

NPI: 1750353876
Provider Name (Legal Business Name): PRESBYTERIAN MAGNETIC RESONANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 COAL AVE SE
ALBUQUERQUE NM
87106-5205
US

IV. Provider business mailing address

PO BOX 94567
ALBUQUERQUE NM
87199-4567
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-5050
  • Fax: 505-766-9006
Mailing address:
  • Phone: 505-243-5050
  • Fax: 505-766-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: ADRIAN BETTS
Title or Position: BILLING DIRECTOR
Credential:
Phone: 505-332-5827