Provider Demographics
NPI:1558416974
Name:ADVANCED IMAGING LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING LLC
Other - Org Name:HIGH RESOLUTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-332-6919
Mailing Address - Street 1:4411 THE 25 WAY NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5857
Mailing Address - Country:US
Mailing Address - Phone:505-332-6919
Mailing Address - Fax:505-332-6921
Practice Address - Street 1:4411 THE 25 WAY NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5857
Practice Address - Country:US
Practice Address - Phone:505-332-6919
Practice Address - Fax:505-332-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPENDINGMedicaid