Provider Demographics
NPI:1740830108
Name:LAD RADIOLOGICAL IMAGING
Entity type:Organization
Organization Name:LAD RADIOLOGICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-463-1638
Mailing Address - Street 1:500 E COURT AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2057
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-237-3979
Practice Address - Street 1:9504 RIVERDALE LN NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5965
Practice Address - Country:US
Practice Address - Phone:505-463-1638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty