1548404825 NPI number — AMIR H. MANOUTCHEHRI M.D. PC

Table of content: (NPI 1548404825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548404825 NPI number — AMIR H. MANOUTCHEHRI M.D. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMIR H. MANOUTCHEHRI M.D. 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:
PINERIDGE-URGENT CARE & MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1548404825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12125 STATE HIGHWAY 14 N.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR CREST
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-407-2174
Provider Business Mailing Address Fax Number:
505-890-7944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12125 STATE HIGHWAY 14 N.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR CREST
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-407-2174
Provider Business Practice Location Address Fax Number:
505-407-2174
Provider Enumeration Date:
04/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANOUTCHEHRI
Authorized Official First Name:
AMIR
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
505-407-2174

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  87108 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 87108 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X , with the licence number: 87-108 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X , with the licence number: 87108 , 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)