1487246229 NPI number — PRESBYTERIAN RUST MEDICAL CENTER ASC LLC

Table of content: (NPI 1487246229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487246229 NPI number — PRESBYTERIAN RUST MEDICAL CENTER ASC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESBYTERIAN RUST MEDICAL CENTER ASC 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:
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:
1487246229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14201 DALLAS PKWY
Provider Second Line Business Mailing Address:
LEGAL- 13TH FLOOR
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-872-4706
Provider Business Mailing Address Fax Number:
972-767-3547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 UNSER BLVD SE
Provider Second Line Business Practice Location Address:
STE 09100B
Provider Business Practice Location Address City Name:
RIO RANCHO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-245-0321
Provider Business Practice Location Address Fax Number:
505-355-5912
Provider Enumeration Date:
02/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BOON
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
480-567-0269

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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