1093071987 NPI number — TASKER HATCH ROWAN LLC

Table of content: (NPI 1093071987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093071987 NPI number — TASKER HATCH ROWAN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TASKER HATCH ROWAN 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:
1093071987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8201 GOLF COURSE RD NW STE C3
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:
87120-5805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-892-9010
Provider Business Mailing Address Fax Number:
505-899-4804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MAIN ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS LUNAS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87031-7559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-865-1999
Provider Business Practice Location Address Fax Number:
505-899-4804
Provider Enumeration Date:
04/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALES
Authorized Official First Name:
EBONIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
505-850-3769

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DD2829 , 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: 22535268 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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