PUEBLO MEDICAL IMAGING, LLC (NPI# 1952353591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952353591 |
| Entity Type | Organization |
| Organization Name | PUEBLO MEDICAL IMAGING, LLC |
| Practice Address |
5495 S Rainbow Blvd Ste 101 Las Vegas NV 89118-1872 |
| Mailing Address |
Po Box 30077 Dept 306 Salt Lake City UT 84130-0077 |
| Practice Telephone | 7022280031 |
| Mailing Telephone | 7022280031 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-03-23 |
| Authorized Official Name | STEVEN M SOGGE (PRESIDENT) |
| Authorized Official Telephone | 7024770772 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085N0700X |
Radiology Specialization: Neuroradiology |
Allopathic & Osteopathic Physicians | ||
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | BCBS OF NV | NV1651 | 01 |
| NV | 100500056 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Pueblo Medical Imaging, LLC | 5495 S. Rainbow Blvd., Suite #203, Las Vegas, NV 89118 |
| Street Address |
5495 S RAINBOW BLVD STE 101 |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89118-1872 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003805045 | Saravanan Valliappan | Radiology | 5495 S Rainbow Blvd Ste 101, Las Vegas, NV 89118-1872 | 2005-10-20 |
| 1265751150 | Kalyan Tatineny | Radiology | 5495 S Rainbow Blvd Ste 101, Las Vegas, NV 89118-1872 | 2010-05-18 |
| 1427288265 | Eric Biesbroeck | Radiology | 5495 S Rainbow Blvd Ste 101, Las Vegas, NV 89118-1872 | 2009-07-14 |
| 1154556314 | Justin Puopolo | Radiology | 5495 S Rainbow Blvd Ste 101, Las Vegas, NV 89118-1872 | 2009-05-18 |
| 1386884252 | Nanette K Bautista | Nurse Practitioner | 5495 S Rainbow Blvd Ste 101, Las Vegas, NV 89118-1872 | 2009-03-04 |
| 1629234323 | Micah Kirk Nielsen | Radiology | 5495 S Rainbow Blvd Ste 101, Las Vegas, NV 89118-1872 | 2008-08-01 |
| 1093918922 | Matthew Michael Treinen | Radiology | 5495 S Rainbow Blvd Ste 101, Las Vegas, NV 89118-1872 | 2007-06-07 |
| 1427276211 | Matthew Ripplinger | Radiology | 5495 S Rainbow Blvd Ste 101, Las Vegas, NV 89118-1872 | 2007-04-24 |
| 1295858439 | Joel Gi-tou Lin | Radiology | 5495 S Rainbow Blvd Ste 101, Las Vegas, NV 89118-1872 | 2007-04-10 |
| 1063538544 | Michael Sanders | Radiology | 5495 S Rainbow Blvd Ste 101, Las Vegas, NV 89118-1872 | 2007-03-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720568520 | Kurt Yaross | Behavioral Analyst | 7138 W Post Rd, #208, Las Vegas, NV 89118 | 2018-08-21 |
| 1619457108 | Michelle Herzberg | Behavioral Analyst | 7318 W Post Rd #280, Las Vegas, NV 89118 | 2018-08-15 |
| 1548749385 | Keisha Bere-ruiz | Behavioral Analyst | 7318 W Post Rd #208, Las Vegas, NV 89118 | 2018-08-13 |
| 1295222081 | Aliantcare | Radiologic Technologist | 5490 S Rainbow Blvd, Suite 400 N34835, Las Vegas, NV 89118 | 2018-04-17 |
| 1710406467 | Anoush H. Tacvorian Do LLC | Clinic/Center | 6525 W. Warm Springs Rd, Suite 100, Las Vegas, NV 89118 | 2017-09-13 |
| 1962920470 | Harvard Medtech, LLC | Durable Medical Equipment & Medical Supplies | 6280 S. Valley View Blvd, Suite 412, Las Vegas, NV 89118 | 2017-09-05 |
| 1750827903 | Kerry Cutler | Nurse Practitioner | 6020 South Rainbow Blvd, Suite C, Las Vegas, NV 89118 | 2017-01-12 |
| 1184173015 | Girisgen & Kopolow Od PC | Optometrist | 7090 S Rainbow Blvd, Ste 100, Las Veegas, NV 89118 | 2016-10-04 |
| 1396117859 | Foundation for Positively Kids | Clinic/Center | 3555 E Reno, Ste F, Las Vegas, NV 89118 | 2015-10-23 |
| 1720492663 | Kiet Michael Lam | Chiropractor | 5693 S. Jones Bvld, Ste 116, Las Vegas, NV 89118 | 2014-06-18 |
| Find all providers in zip 89118 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346860624 | Smi Imaging LLC | Radiology | 7455 W Washington Ave Ste 120, Las Vegas, NV 89128-4338 | 2020-04-16 |
| 1548807274 | Smi Imaging LLC | Radiology | 3560 W Flamingo Rd, Ste 100, Las Vegas, NV 89121-5088 | 2019-12-02 |
| 1316583297 | Smi Imaging LLC | Radiology | 8530 W Sunset Rd Ste 120, Las Vegas, NV 89113-2244 | 2019-11-26 |
| 1114563095 | Smi Imaging LLC | Radiology | 7540 Oso Blanca Rd Ste 140, Las Vegas, NV 89149-1417 | 2019-11-26 |
| 1396381273 | Smi Imaging LLC | Radiology | 7610 W Cheyenne Ave Ste 100, Las Vegas, NV 89129-6761 | 2019-11-26 |
| 1740826627 | Smi Imaging LLC | Radiology | 3061 S Maryland Pkwy Ste 102, Las Vegas, NV 89109-6226 | 2019-11-26 |
| 1366000622 | 6radiology | Radiology | 11266 Parleys Cone Ct, Las Vegas, NV 89135-1839 | 2019-06-03 |
| 1396271698 | Cheryl Jayne | Radiology | 2225 Scarlet Rose Dr, Las Vegas, NV 89134-5905 | 2017-05-04 |
| 1174997407 | Sutter Valley Medical Foundation | Radiology | 2995 American River Ln, Las Vegas, NV 89135-1713 | 2015-11-24 |
| 1467879205 | Ross Leon Prujan | Radiology | 11663 Glowing Sunset Ln, Las Vegas, NV 89135-1659 | 2014-03-18 |
| Find all providers in LAS VEGAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.