1780697300 NPI number — DR. LINDA MARIE STOGNER M.D.

Table of content: DR. LINDA MARIE STOGNER M.D. (NPI 1780697300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780697300 NPI number — DR. LINDA MARIE STOGNER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOGNER
Provider First Name:
LINDA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1780697300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 158
Provider Second Line Business Mailing Address:
701 ALLEN
Provider Business Mailing Address City Name:
ESTANCIA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87016-0158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-384-5068
Provider Business Mailing Address Fax Number:
505-384-2204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ESPERANZA FAMILY HEALTH CENTER
Provider Second Line Business Practice Location Address:
903 C FIFTH ST
Provider Business Practice Location Address City Name:
ESTANCIA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-384-2777
Provider Business Practice Location Address Fax Number:
505-384-2204
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  86-377 , 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)

  • Identifier: 10000284 . This is a "LOVELACE HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 37648 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201009665 . This is a "PRESBYTERIAN HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 80147920 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM002714 . This is a "BLUECROSSBLUESHIELD OF NEW MEXICO" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1727557 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 850206810 . This is a "TRICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: PROVP16276 . This is a "MOLINA HEALTHCARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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