=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326773482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT IMAGING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2022
-----------------------------------------------------
Last Update Date | 01/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 821 LEXINGTON RD
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88101-4466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-763-6144
-----------------------------------------------------
Fax | 575-763-6147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 821 LEXINGTON RD
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88101-4466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-763-6144
-----------------------------------------------------
Fax | 575-763-6147
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING
-----------------------------------------------------
Name | LISSETTE RAMIREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 575-763-6144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------