Imaging Center of Clovis, LLC

Primary specialty

Mammography Clinic/CenterTaxonomy code 261QR0206X

Legal business name

IMAGING CENTER OF CLOVIS, LLC

Practice address

2105 W 21St St
Clovis, NM 88101-4017

Phone

(575) 935-9729

Fax

(575) 935-9731

NPI assigned

Sep 20, 2011

Last updated

Sep 20, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jeananne Mazzolini, RT( R)( M)

Title

Owner

Phone

(575) 693-3770

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1740563444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 W 21ST ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014017",
            "telephone_number": "575-935-9729",
            "fax_number": "575-935-9731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 W 21ST ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014017",
            "telephone_number": "575-935-9729",
            "fax_number": "575-935-9731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGING CENTER OF CLOVIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-20",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "MAZZOLINI",
        "authorized_official_first_name": "JEANANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "575-693-3770",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RT( R)( M)"
    },
    "taxonomies": [
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mammography Clinic/Center in Clovis, NM
• Providers in Clovis, NM by specialty
• Mammography Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.