Provider Demographics
NPI:1922345990
Name:QUALITY MEDICAL IMAGING OF NEW MEXICO INC
Entity Type:Organization
Organization Name:QUALITY MEDICAL IMAGING OF NEW MEXICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:FASELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-839-1133
Mailing Address - Street 1:2490 PROFESSIONAL CT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0835
Mailing Address - Country:US
Mailing Address - Phone:702-839-1133
Mailing Address - Fax:702-629-4711
Practice Address - Street 1:6501 4TH STREET NW
Practice Address - Street 2:SUITE H 5
Practice Address - City:ALBURQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87505-1834
Practice Address - Country:US
Practice Address - Phone:866-508-4870
Practice Address - Fax:866-274-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM46835012471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty