Provider Demographics
NPI:1497484711
Name:ROADRUNNER MOBILE XRAY LLC
Entity Type:Organization
Organization Name:ROADRUNNER MOBILE XRAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KA
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RVT
Authorized Official - Phone:505-350-3397
Mailing Address - Street 1:3825 EUBANK BLVD NE STE D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3559
Mailing Address - Country:US
Mailing Address - Phone:505-350-3397
Mailing Address - Fax:505-323-7980
Practice Address - Street 1:3825 EUBANK BLVD NE STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3559
Practice Address - Country:US
Practice Address - Phone:505-350-3397
Practice Address - Fax:505-323-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier