Healthcare Provider Details

I. General information

NPI: 1740830108
Provider Name (Legal Business Name): LAD RADIOLOGICAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9504 RIVERDALE LN NW
ALBUQUERQUE NM
87114-5965
US

IV. Provider business mailing address

500 E COURT AVE STE 305
DES MOINES IA
50309-2057
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-1638
  • Fax:
Mailing address:
  • Phone: 515-237-3974
  • Fax: 515-237-3979

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: LANCE DELL
Title or Position: OWNER
Credential:
Phone: 505-463-1638