=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306197116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHER ULTRASOUND SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2012
-----------------------------------------------------
Last Update Date | 09/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 412 W MAIN ST
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88210-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-746-3662
-----------------------------------------------------
Fax | 188-855-9521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 657
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88211-0657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-513-1503
-----------------------------------------------------
Fax | 188-855-9521
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MRS. MENDY L BELTRAN
-----------------------------------------------------
Credential | RDMS, RVT, RCS
-----------------------------------------------------
Telephone | 575-513-1503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number | 60666
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------