1194021402 NPI number — MICHAEL T SANCHEZ CRNA

Table of content: MICHAEL T SANCHEZ CRNA (NPI 1194021402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194021402 NPI number — MICHAEL T SANCHEZ CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANCHEZ
Provider First Name:
MICHAEL
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1194021402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 LOUISIANA BLVD NE
Provider Second Line Business Mailing Address:
SUITE #401
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-7022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-260-4300
Provider Business Mailing Address Fax Number:
505-260-4371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 CENTRAL SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBU
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-841-1234
Provider Business Practice Location Address Fax Number:
505-841-1956
Provider Enumeration Date:
02/03/2011

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: 367500000X , with the licence number:  SRA 100025 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: CRNA-01156 , 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: 643406 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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