Healthcare Provider Details

I. General information

NPI: 1497484711
Provider Name (Legal Business Name): ROADRUNNER MOBILE XRAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EUBANK BLVD NE STE D
ALBUQUERQUE NM
87111-3559
US

IV. Provider business mailing address

3825 EUBANK BLVD NE STE D
ALBUQUERQUE NM
87111-3559
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-3397
  • Fax: 505-323-7980
Mailing address:
  • Phone: 505-350-3397
  • Fax: 505-323-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN K.A JAIN JR.
Title or Position: CEO
Credential: RVT
Phone: 505-350-3397