Organization
LAS CRUCES IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMAKRISHNA DEVASTHALI (MD/PRESIDENT)
(575) 532-7000
Entity
Organization
Contact information
Practice address
160 ROADRUNNER PARKWAY, LAS CRUCES, NM 88011
(575) 556-1800
Mailing address
205 W. BOUTZ RD. BLDG #1, LAS CRUCES, NM 88005
(575) 532-7000
Taxonomy
Speciality
Code
Description
License number
State
261QR0206X
Mammography Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04850858
—
NM
01
—
NM007F99
BCBS OF NM
NM
01
—
P00210768
RR MEDICARE
—
Enumeration date
06/13/2006
Last updated
06/30/2009
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