Healthcare Provider Details

I. General information

NPI: 1245010610
Provider Name (Legal Business Name): OSSP IMAGING OF ALBUQUERQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 JEFFERSON LN NE
ALBUQUERQUE NM
87109-2120
US

IV. Provider business mailing address

5788 ROSWELL RD
ATLANTA GA
30328-4904
US

V. Phone/Fax

Practice location:
  • Phone: 678-752-7246
  • Fax:
Mailing address:
  • Phone: 678-752-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAITH A BELTZHOOVER
Title or Position: RCM DIRECTOR
Credential:
Phone: 678-752-7246