Provider Demographics
NPI:1700548708
Name:X-RAYS ON DEMAND ALB LLC
Entity Type:Organization
Organization Name:X-RAYS ON DEMAND ALB LLC
Other - Org Name:X-RAYS ON DEMAND ALB
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANN-NAVA
Authorized Official - Suffix:
Authorized Official - Credentials:AAS
Authorized Official - Phone:505-903-1039
Mailing Address - Street 1:1804 JUNE ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3146
Mailing Address - Country:US
Mailing Address - Phone:505-903-1039
Mailing Address - Fax:505-213-2967
Practice Address - Street 1:1804 JUNE ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3146
Practice Address - Country:US
Practice Address - Phone:505-903-1039
Practice Address - Fax:505-213-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM6549721OtherSECRETARY OF STATE BUSINESS ID