Provider Demographics
NPI:1730130410
Name:TRANSRAY DIAGNOSTIC, INC.
Entity Type:Organization
Organization Name:TRANSRAY DIAGNOSTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CONSTANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-717-6018
Mailing Address - Street 1:PO BOX 70035
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87197-0035
Mailing Address - Country:US
Mailing Address - Phone:505-717-6018
Mailing Address - Fax:
Practice Address - Street 1:703 OSUNA RD NE
Practice Address - Street 2:SUITE 3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1391
Practice Address - Country:US
Practice Address - Phone:505-717-6018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMFA00361982471C3402X
NMRRT00642335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM56820577Medicaid
NM56820577Medicaid