Provider Demographics
NPI:1346312642
Name:AXIOM IMAGING OF LAS VEGAS LLC
Entity Type:Organization
Organization Name:AXIOM IMAGING OF LAS VEGAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:702-868-2781
Mailing Address - Street 1:6460 MEDICAL CENTER ST
Mailing Address - Street 2:STE. 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2406
Mailing Address - Country:US
Mailing Address - Phone:702-868-2781
Mailing Address - Fax:702-868-2782
Practice Address - Street 1:6460 MEDICAL CENTER ST
Practice Address - Street 2:STE. 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2406
Practice Address - Country:US
Practice Address - Phone:702-868-2781
Practice Address - Fax:702-868-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty