1417901612 NPI number — HEALTHFRONT PC

Table of content: (NPI 1417901612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417901612 NPI number — HEALTHFRONT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHFRONT 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:
NORTHERN NEW MEXICO EMERGENCY MEDICAL SERVICES PC
Provider Other Organization Name Type Code:
4
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:
1417901612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 844449
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-4449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-579-7777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 SAINT MICHAELS DR
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:
87505-7601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-983-3361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEST
Authorized Official First Name:
MEHER
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
505-440-8440

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14924 . This is a "PRESYBETERIAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM007002 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32D0920783 . This is a "CLIA WAIVER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000K8226 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187732400 . This is a "DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: CD2579 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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