Provider Demographics
NPI:1689906042
Name:EE RAD NM, INC
Entity Type:Organization
Organization Name:EE RAD NM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:K
Authorized Official - Last Name:SITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-652-1200
Mailing Address - Street 1:12100 SUNRISE VALLEY
Mailing Address - Street 2:SUITE 290-B
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191
Mailing Address - Country:US
Mailing Address - Phone:703-652-1200
Mailing Address - Fax:703-880-7401
Practice Address - Street 1:800 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1954
Practice Address - Country:US
Practice Address - Phone:703-652-1200
Practice Address - Fax:703-880-7401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLEEYE RADIOLOGY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty