Provider Demographics
NPI:1902476203
Name:ABQ MRI, LLC
Entity type:Organization
Organization Name:ABQ MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:JOCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-361-1931
Mailing Address - Street 1:7901 JOHN CARPENTER FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4832
Mailing Address - Country:US
Mailing Address - Phone:505-514-2292
Mailing Address - Fax:
Practice Address - Street 1:3911 4TH ST NW STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2510
Practice Address - Country:US
Practice Address - Phone:505-361-1931
Practice Address - Fax:505-521-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty