Healthcare Provider Details

I. General information

NPI: 1497855381
Provider Name (Legal Business Name): SUMMIT IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 LEXINGTON RD
CLOVIS NM
88101-4466
US

IV. Provider business mailing address

821 LEXINGTON RD
CLOVIS NM
88101-4466
US

V. Phone/Fax

Practice location:
  • Phone: 575-763-6144
  • Fax: 575-763-6147
Mailing address:
  • Phone: 575-763-6144
  • Fax: 575-763-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSE MARTIN
Title or Position: OWNER
Credential:
Phone: 575-763-6144