1407064926 NPI number — NMDOH PHD BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM

Table of content: (NPI 1407064926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407064926 NPI number — NMDOH PHD BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NMDOH PHD BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM
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:
1407064926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 CENTRAL AVE NE
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87108-1513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-841-5837
Provider Business Mailing Address Fax Number:
505-222-8602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 CENTRAL AVE NE
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87108-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-841-5837
Provider Business Practice Location Address Fax Number:
505-222-8602
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HICKOK
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
NMDOH PHD CHIEF NURSE
Authorized Official Telephone Number:
505-841-5890

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com