1639667389 NPI number — CACHOMED HEALTH PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639667389 NPI number — CACHOMED HEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CACHOMED HEALTH PC
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:
1639667389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 CORDOVA PL # 86
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-1725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-954-1459
Provider Business Mailing Address Fax Number:
505-466-1729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
531 HARKLE RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-954-1459
Provider Business Practice Location Address Fax Number:
505-983-7571
Provider Enumeration Date:
04/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RADUNSKY
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-954-1459

Provider Taxonomy Codes

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

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

  • Identifier: 59781068 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com