Healthcare Provider Details

I. General information

NPI: 1306829213
Provider Name (Legal Business Name): ON SITE RADIOGRAPHY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 RELAMPAGO ST NW
ALBUQUERQUE NM
87120-1501
US

IV. Provider business mailing address

7208 RELAMPAGO ST NW
ALBUQUERQUE NM
87120-1501
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-9836
  • Fax: 505-332-9825
Mailing address:
  • Phone: 505-843-9836
  • Fax: 505-332-9825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number03006400007
License Number StateNM

VIII. Authorized Official

Name: MRS. APRIL MONTANO
Title or Position: CEO
Credential: R.T.
Phone: 505-843-9836