Provider Demographics
NPI:1275759391
Name:NEW MEXICO IMAGING AND WELLNESS
Entity Type:Organization
Organization Name:NEW MEXICO IMAGING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TERLUN
Authorized Official - Last Name:BADAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-238-7400
Mailing Address - Street 1:4 TENNIS CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1810
Mailing Address - Country:US
Mailing Address - Phone:505-238-7400
Mailing Address - Fax:
Practice Address - Street 1:401 EDITH BLVD
Practice Address - Street 2:SUITE B-1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2509
Practice Address - Country:US
Practice Address - Phone:505-238-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology