Provider Demographics
NPI:1134589716
Name:HIGH DESERT IMAGING LLC
Entity type:Organization
Organization Name:HIGH DESERT IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-445-5500
Mailing Address - Street 1:PO BOX 1625
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0027
Mailing Address - Country:US
Mailing Address - Phone:775-621-5800
Mailing Address - Fax:775-621-5801
Practice Address - Street 1:2110 IDAHO ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2625
Practice Address - Country:US
Practice Address - Phone:775-621-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty