Provider Demographics
NPI:1881981272
Name:EL PASO IMAGING CONSULTANTS PLLC
Entity type:Organization
Organization Name:EL PASO IMAGING CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHETAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-861-1013
Mailing Address - Street 1:661 S MESA HILLS DR
Mailing Address - Street 2:STE 102
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5550
Mailing Address - Country:US
Mailing Address - Phone:800-522-1952
Mailing Address - Fax:575-532-7025
Practice Address - Street 1:4845 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:575-532-7000
Practice Address - Fax:575-532-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287947001Medicaid