Provider Demographics
NPI:1356473037
Name:CORDISONICS PC
Entity Type:Organization
Organization Name:CORDISONICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MILO
Authorized Official - Middle Name:
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-491-7142
Mailing Address - Street 1:2535 CHERRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-7700
Mailing Address - Country:US
Mailing Address - Phone:575-491-7142
Mailing Address - Fax:575-443-1771
Practice Address - Street 1:2010 PECAN DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4746
Practice Address - Country:US
Practice Address - Phone:575-491-7142
Practice Address - Fax:505-443-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM30037246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM007E80OtherBLUE CROSS BLUE SHIELD
NM21070822Medicaid