Provider Demographics
NPI:1669347787
Name:MD-SCAN MRI CORP
Entity type:Organization
Organization Name:MD-SCAN MRI CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-639-3829
Mailing Address - Street 1:2525 S TELSHOR BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9148
Mailing Address - Country:US
Mailing Address - Phone:575-639-3829
Mailing Address - Fax:575-556-9062
Practice Address - Street 1:10737 GATEWAY BLVD W STE 340
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4910
Practice Address - Country:US
Practice Address - Phone:575-639-3829
Practice Address - Fax:575-556-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty