Provider Demographics
NPI:1891049268
Name:LAND OF ENCHANTMENT DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:LAND OF ENCHANTMENT DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-792-6886
Mailing Address - Street 1:3620 BOSQUE PLZ NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4297
Mailing Address - Country:US
Mailing Address - Phone:505-792-6886
Mailing Address - Fax:877-296-3211
Practice Address - Street 1:3620 BOSQUE PLZ NW
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4297
Practice Address - Country:US
Practice Address - Phone:505-792-6886
Practice Address - Fax:877-296-3211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAND OF ENCHANTMENT SPINE SURGERY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-06
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD125395Medicare UPIN