Healthcare Provider Details

I. General information

NPI: 1275759391
Provider Name (Legal Business Name): NEW MEXICO IMAGING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 EDITH BLVD SUITE B-1
ALBUQUERQUE NM
87102-2509
US

IV. Provider business mailing address

4 TENNIS CT NW
ALBUQUERQUE NM
87120-1810
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-7400
  • Fax:
Mailing address:
  • Phone: 505-238-7400
  • 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: MR. JOHN TERLUN BADAL
Title or Position: PRESIDENT
Credential:
Phone: 505-238-7400