1508191206 NPI number — VESSEL HEALTH LLC

Table of content: (NPI 1508191206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508191206 NPI number — VESSEL HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VESSEL HEALTH LLC
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:
1508191206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7920 WYOMING BLVD. NE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-6021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-828-3000
Provider Business Mailing Address Fax Number:
505-828-3002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7920 WYOMING BLVD NE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-6020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-828-3000
Provider Business Practice Location Address Fax Number:
505-828-3002
Provider Enumeration Date:
10/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
HARVEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-828-3000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  89-133 , 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)