1932206117 NPI number — MEDICINE AT DOWNTOWN LTD.

Table of content: (NPI 1932206117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932206117 NPI number — MEDICINE AT DOWNTOWN LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICINE AT DOWNTOWN LTD.
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932206117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 313
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87103-0313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-246-1670
Provider Business Mailing Address Fax Number:
505-246-1677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 COAL AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102-3743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-246-1670
Provider Business Practice Location Address Fax Number:
505-246-1677
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
UNVERZAGT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-246-1670

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  03-061797-00-9 , 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)