1578839163 NPI number — IPC HOSPITALISTS OF NEW MEXICO, INC

Table of content: (NPI 1578839163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578839163 NPI number — IPC HOSPITALISTS OF NEW MEXICO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IPC HOSPITALISTS OF NEW MEXICO, INC
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:
1578839163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8208 LOUISIANA BLVD NE
Provider Second Line Business Mailing Address:
STE. C
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87113-1757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8208 LOUISIANA BLVD NE
Provider Second Line Business Practice Location Address:
STE. C
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87113-1757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-789-0344
Provider Business Practice Location Address Fax Number:
602-870-7566
Provider Enumeration Date:
03/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
R. JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & COO
Authorized Official Telephone Number:
818-766-3502

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 27573371 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 889234086 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com