1194140277 NPI number — DUKE CITY HEALTHCARE

Table of content: (NPI 1194140277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194140277 NPI number — DUKE CITY HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUKE CITY HEALTHCARE
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:
1194140277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4411 MONTANO RD NW
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87120-3235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-899-4414
Provider Business Mailing Address Fax Number:
505-898-2395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4411 MONTANO RD NW
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87120-3235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-899-4414
Provider Business Practice Location Address Fax Number:
505-898-2395
Provider Enumeration Date:
02/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FURY
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
Authorized Official Title or Position:
CFNP/OWNER
Authorized Official Telephone Number:
505-899-4414

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MD2004-0125 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X , with the licence number: CNP01240 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1467535658 . This is a "NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 43129846 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202023190 . This is a "PRESBYTERIAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1568482701 . This is a "NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM006H53 . This is a "BLUE CROSS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: Q76696 . This is a "UPIN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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