Healthcare Provider Details

I. General information

NPI: 1629592464
Provider Name (Legal Business Name): IMAGING ASSOCIATES OF NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

PO BOX 85506
CHICAGO IL
60689-5506
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-8000
  • Fax:
Mailing address:
  • Phone: 505-225-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN MARIE VAUGHN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 629-317-1465