Provider Demographics
NPI:1407012388
Name:TAOS SPORTS MEDICINE SERVICES LLC
Entity Type:Organization
Organization Name:TAOS SPORTS MEDICINE SERVICES LLC
Other - Org Name:DBA TAOS MRI SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-737-0304
Mailing Address - Street 1:1398 WEIMER RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6397
Mailing Address - Country:US
Mailing Address - Phone:575-737-0304
Mailing Address - Fax:
Practice Address - Street 1:1398 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6397
Practice Address - Country:US
Practice Address - Phone:575-737-0304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM30722471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM650024576Medicare PIN