Provider Demographics
NPI:1730259805
Name:NEW MEXICO SONOGRAPHICS INC
Entity type:Organization
Organization Name:NEW MEXICO SONOGRAPHICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-875-1583
Mailing Address - Street 1:4600 A MONTGOMERY NE
Mailing Address - Street 2:STE 105
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1292
Mailing Address - Country:US
Mailing Address - Phone:505-875-1583
Mailing Address - Fax:505-830-2023
Practice Address - Street 1:4600 A MONTGOMERY NE
Practice Address - Street 2:STE 105
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1292
Practice Address - Country:US
Practice Address - Phone:505-875-1583
Practice Address - Fax:505-830-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471C3402X, 207VM0101X
NM2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43927858Medicaid
NM52415Medicaid