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NPI Code Detail

MEDICARE: QUALITY MEDICAL IMAGING OF NEVADA LLC.

MEDICARE: QUALITY MEDICAL IMAGING OF NEVADA LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335V00000XPortable X-ray and/or Other Portable Diagnostic Imaging SupplierLLC5073-2001NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1630001670OTHERNVRAILROAD MEDICARE ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104823368
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUALITY MEDICAL IMAGING OF NEVADA LLC.
Provider Business Mailing Address
First Line : 2490 PROFESSIONAL CT
Second Line : SUITE 110
City : LAS VEGAS
State : NV
Zip : 89128-0825
Country : US
Telephone Number : 702-839-1133
Fax Number : 702-851-1616
Provider Business Practice Location Address
First Line : 2490 PROFESSIONAL CT
Second Line : SUITE 110
City : LAS VEGAS
State : NV
Zip : 89128-0825
Country : US
Telephone Number : 702-839-1133
Fax Number : 702-851-1616
Authorized Official
Title or Position : PRESIDENT
Name : MR. ROGER C FASELT
Credential :
Telephone Number : 702-839-1133
Provider Enumeration Date : 07/02/2005
Last Update Date : 05/25/2016

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Directions to “QUALITY MEDICAL IMAGING OF NEVADA LLC. ” Practice Location

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