1578719209 NPI number — NEW MEXICO INNER WELLNESS CENTER, INC

Table of content: (NPI 1578719209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578719209 NPI number — NEW MEXICO INNER WELLNESS CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MEXICO INNER WELLNESS CENTER, INC
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:
6
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:
1578719209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 91960
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:
87199-1960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-884-8900
Provider Business Mailing Address Fax Number:
505-806-7183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950C OLD US 66
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87015-6745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-884-8900
Provider Business Practice Location Address Fax Number:
888-699-4725
Provider Enumeration Date:
08/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROWE
Authorized Official First Name:
JULIAN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-884-8900

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  97-136 , 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)





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