Healthcare Provider Details

I. General information

NPI: 1528166196
Provider Name (Legal Business Name): ELKO DIAGNOSTIC IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1784 BROWNING WAY SUITE B
ELKO NV
89801-8356
US

IV. Provider business mailing address

PO BOX 23001
PASADENA CA
91185-0001
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-9431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ROSS H GOLDING
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 775-323-5083