Provider Demographics
NPI:1104823368
Name:QUALITY MEDICAL IMAGING OF NEVADA LLC.
Entity Type:Organization
Organization Name:QUALITY MEDICAL IMAGING OF NEVADA LLC.
Other - Org Name:QUALITY MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:FASELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-839-1133
Mailing Address - Street 1:2490 PROFESSIONAL CT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0825
Mailing Address - Country:US
Mailing Address - Phone:702-839-1133
Mailing Address - Fax:702-851-1616
Practice Address - Street 1:2490 PROFESSIONAL CT
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0825
Practice Address - Country:US
Practice Address - Phone:702-839-1133
Practice Address - Fax:702-851-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-02
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLLC5073-2001335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV630001670OtherRAILROAD MEDICARE ID
NV002702036Medicaid
NV630001670OtherRAILROAD MEDICARE ID