Healthcare Provider Details

I. General information

NPI: 1346280021
Provider Name (Legal Business Name): CARLSBAD OPEN MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 WEST PIERCE STREET, SUITE A
CARLSBAD NM
88220
US

IV. Provider business mailing address

2319 WEST PIERCE STREET, SUITE A
CARLSBAD NM
88220
US

V. Phone/Fax

Practice location:
  • Phone: 505-628-1234
  • Fax: 505-628-3215
Mailing address:
  • Phone: 505-628-1234
  • Fax: 505-628-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number53169-01
License Number StateNM

VIII. Authorized Official

Name: MR. KEMP B LAIDLEY
Title or Position: MANAGING PARTNER
Credential:
Phone: 505-628-1234