Organization
LAS CRUCES PET IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHUCK WILTSHIRE (CEO)
(919) 349-6300
Entity
Organization
Contact information
Practice address
1121 MALL DRIVE, SUITE D, LAS CRUCES, NM 88011-8102
(575) 522-5540
(575) 522-3259
Mailing address
P.O. BOX 676072, DALLAS, TX 75267-6072
(740) 266-4908
(740) 264-4376
Taxonomy
Speciality
Code
Description
License number
State
2471N0900X
Nuclear Medicine Technology Radiologic Technologist
Primary
3834
NM
2471N0900X
Nuclear Medicine Technology Radiologic Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49439065
—
NM
Enumeration date
07/04/2006
Last updated
01/19/2012
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