Organization
SUMMIT IMAGING LLC
Active
Organization
SUMMIT IMAGING LLC
Active
Other names
Clovis Open MRI
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE MARTIN (OWNER)
(575) 763-6144
Entity
Organization
Contact information
Practice address
821 LEXINGTON RD, CLOVIS, NM 88101-4466
(575) 763-6144
(575) 763-6147
Mailing address
821 LEXINGTON RD, CLOVIS, NM 88101-4466
(575) 763-6144
(575) 763-6147
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04074975
—
NM
05
—
95687262
—
NM
01
—
P00182692
RR MEDICARE
—
Enumeration date
09/22/2006
Last updated
10/03/2022
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