Provider Demographics
NPI:1780848135
Name:LAS CRUCES IMAGING LLC
Entity Type:Organization
Organization Name:LAS CRUCES IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMAKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVASTHALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-532-7000
Mailing Address - Street 1:205 W BOUTZ RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3259
Mailing Address - Country:US
Mailing Address - Phone:575-532-7000
Mailing Address - Fax:
Practice Address - Street 1:160 S ROADRUNNER PKWY
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7044
Practice Address - Country:US
Practice Address - Phone:575-556-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM800521138Medicare PIN