Provider Demographics
NPI:1972512994
Name:INNERFACE IMAGING LLC
Entity type:Organization
Organization Name:INNERFACE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:FICHTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-314-1669
Mailing Address - Street 1:4630 EUBANK BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-323-9906
Mailing Address - Fax:505-298-7227
Practice Address - Street 1:10100 N CENTRAL EXPRESSWAY
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-346-9129
Practice Address - Fax:214-346-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTX199Medicare ID - Type Unspecified