1275604431 NPI number — REHABILITATION MEDICINE ASSOCIATES OF NORTHERN NEW MEXICO PC

Table of content: (NPI 1275604431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275604431 NPI number — REHABILITATION MEDICINE ASSOCIATES OF NORTHERN NEW MEXICO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION MEDICINE ASSOCIATES OF NORTHERN NEW MEXICO PC
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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1275604431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1691 GALISTEO ST STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-4781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-983-2233
Provider Business Mailing Address Fax Number:
505-983-2290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1691 GALISTEO ST STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-4781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-983-2233
Provider Business Practice Location Address Fax Number:
505-983-2290
Provider Enumeration Date:
11/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
BELYN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-983-2233

Provider Taxonomy Codes

  • Taxonomy code: 225400000X , with the licence number:  94-387 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00NM009445 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 26049 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".