1750580411 NPI number — PEDIATRIX CARDIOLOGY OF NEW MEXICO, P.C.

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 1750580411 NPI number — PEDIATRIX CARDIOLOGY OF NEW MEXICO, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIX CARDIOLOGY OF NEW MEXICO, P.C.
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:
1750580411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4722 N 24TH ST
Provider Second Line Business Mailing Address:
STE. 150
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-256-4628
Provider Business Mailing Address Fax Number:
855-851-4319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 CEDAR ST SE
Provider Second Line Business Practice Location Address:
STE. 700
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106-4917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-848-3700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KURZWEIL
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
602-256-4628

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 71032860 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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