1043225493 NPI number — ALAMOGORDO PHYSICAL THERAPY & WELLNESS CENTER, INC

Table of content: (NPI 1043225493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043225493 NPI number — ALAMOGORDO PHYSICAL THERAPY & WELLNESS CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAMOGORDO PHYSICAL THERAPY & WELLNESS CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALAMOGORDO PHYSICAL THERAPY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043225493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2860
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOGORDO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88311-2860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-439-1397
Provider Business Mailing Address Fax Number:
575-437-2622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2351 INDIAN WELLS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88310-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-439-1397
Provider Business Practice Location Address Fax Number:
575-437-2622
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATTILLO
Authorized Official First Name:
MELYNN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
575-439-1397

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3137 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: 3137 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 83161 . This is a "PRESBYTERIAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NMB2218 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27851729 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2298 . This is a "LOVELACE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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