NPIMap

Organization Active NPI

Vascular Diagnostic Lab

  • Physiological Laboratory
  • Las Cruces, NM
National Provider Identifier
1245454073
Registry record updated Dec 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
VASCULAR DIAGNOSTIC LAB
Practice address
3850 Foothills Rd.
#3
Las Cruces, NM 88011-8268
Phone
(575) 522-5511
Fax
(575) 522-0825
NPI assigned
Apr 12, 2007
Last updated
Dec 31, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Rita Polsky
Title
Administrator
Phone
(575) 635-7145

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

3850 Foothills Rd.
#3
Las Cruces, NM 88011-8268

Mailing address

P.O. Box 6366
Las Cruces, NM 88006-6366
Phone (575) 522-5511

Other identifiers 1

IdentifierTypeStateIssuer
00052597MedicaidNM

National Provider Directory

National Provider Directory

Locations

755 S Telshor Blvd
Ste 101F
Las Cruces, NM 88011
Phone (505) 522-0423

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419984000000",
    "number": "1245454073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 6366",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880066366",
            "telephone_number": "575-522-5511",
            "fax_number": "575-522-0825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 FOOTHILLS RD.",
            "address_2": "#3",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118268",
            "telephone_number": "575-522-5511",
            "fax_number": "575-522-0825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VASCULAR DIAGNOSTIC LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2014-12-31",
        "status": "A",
        "authorized_official_last_name": "POLSKY",
        "authorized_official_first_name": "RITA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "575-635-7145",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00052597",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.