Provider Demographics
NPI:1346910916
Name:STAMMDO IMAGING AND DIAGNOSTIC, LLC
Entity Type:Organization
Organization Name:STAMMDO IMAGING AND DIAGNOSTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:POPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-738-9666
Mailing Address - Street 1:2575 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-5092
Mailing Address - Country:US
Mailing Address - Phone:775-738-9666
Mailing Address - Fax:
Practice Address - Street 1:2575 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-5092
Practice Address - Country:US
Practice Address - Phone:775-738-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology