Healthcare Provider Details

I. General information

NPI: 1396703096
Provider Name (Legal Business Name): INDEPENDENT MRI CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E 30TH ST
FARMINGTON NM
87401-9020
US

IV. Provider business mailing address

1750 E 30TH ST
FARMINGTON NM
87401-9020
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-0123
  • Fax: 505-327-0127
Mailing address:
  • Phone: 505-327-0123
  • Fax: 505-327-0127

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: DR. PETER MORRIS SALTZMAN
Title or Position: OWNER-PARTNER
Credential: M.D.
Phone: 505-327-0333