Healthcare Provider Details

I. General information

NPI: 1275280414
Provider Name (Legal Business Name): VISIONARY DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 WYOMING BLVD NE
ALBUQUERQUE NM
87109-3932
US

IV. Provider business mailing address

803 SILVER AVE SW
ALBUQUERQUE NM
87102-3020
US

V. Phone/Fax

Practice location:
  • Phone: 505-444-2032
  • Fax:
Mailing address:
  • Phone: 505-444-2032
  • Fax:

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: DR. ALLEN ROY MINER
Title or Position: OWNER
Credential: DC
Phone: 505-444-2032