Provider Demographics
NPI:1841064789
Name:ALBUQUERQUE MRI
Entity type:Organization
Organization Name:ALBUQUERQUE MRI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:JOCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-361-1931
Mailing Address - Street 1:4630 JEFFERSON LN NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2117
Mailing Address - Country:US
Mailing Address - Phone:505-361-1931
Mailing Address - Fax:
Practice Address - Street 1:4630 JEFFERSON LN NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2117
Practice Address - Country:US
Practice Address - Phone:505-361-1931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology