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General NPI Number Information
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NPI Number | 1225524531
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Entity Type | Organization
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Legal Business Name | MDIG OF NEW MEXICO, LLC
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 10835 N 25TH AVE STE 240
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City | PHOENIX
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State | AZ
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Zip | 85029-3458
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Country | US
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Telephone | 480-999-1091
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Fax | 602-812-4985
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Provider Business Mailing Address
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Address Line | 10835 N 25TH AVE STE 140
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City | PHOENIX
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State | AZ
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Zip | 85029-3408
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Country | US
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Telephone | 480-999-1091
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Fax | 602-812-4985
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Authorized Official
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Title or Position | RCM-OPERATIONS MANAGER
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Name | MS. TRACY PRINCE
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Credential | MANAGER
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Telephone | 480-999-1091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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