1700393782 NPI number — MCLEOD MEDICAL CENTERS OF NM, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700393782 NPI number — MCLEOD MEDICAL CENTERS OF NM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLEOD MEDICAL CENTERS OF NM, 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:
1700393782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12127B HWY 14 N STE 5
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:
87008-9499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-281-5180
Provider Business Mailing Address Fax Number:
505-281-5320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12127B HWY 14 N STE 5
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:
87008-9499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-281-5180
Provider Business Practice Location Address Fax Number:
505-281-5320
Provider Enumeration Date:
12/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MARRUFO
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
505-916-6544

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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