Healthcare Provider Details

I. General information

NPI: 1730259805
Provider Name (Legal Business Name): NEW MEXICO SONOGRAPHICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 A MONTGOMERY NE STE 105
ALBUQUERQUE NM
87109-1292
US

IV. Provider business mailing address

4600 A MONTGOMERY NE STE 105
ALBUQUERQUE NM
87109-1292
US

V. Phone/Fax

Practice location:
  • Phone: 505-875-1583
  • Fax: 505-830-2023
Mailing address:
  • Phone: 505-875-1583
  • Fax: 505-830-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA JETER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 505-875-1583