Provider Demographics
NPI:1235253071
Name:TRANSRAY DIAGNOSTIC, INC
Entity Type:Organization
Organization Name:TRANSRAY DIAGNOSTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:TASSOTTI
Authorized Official - Last Name:CONSTANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-899-4018
Mailing Address - Street 1:9700 CONEFLOWER DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3440
Mailing Address - Country:US
Mailing Address - Phone:505-899-4018
Mailing Address - Fax:
Practice Address - Street 1:2800 SAN MATEO BLVD NE STE 108
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3166
Practice Address - Country:US
Practice Address - Phone:505-883-0475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM56820577Medicaid