1821189101 NPI number — BHASKER MEDICAL CLINIC PC

Table of content: (NPI 1821189101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821189101 NPI number — BHASKER MEDICAL CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BHASKER MEDICAL CLINIC 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:
1821189101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 NEEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOCORRO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87801-4649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-835-2940
Provider Business Mailing Address Fax Number:
575-835-2216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 NEEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOCORRO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87801-4649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-835-2940
Provider Business Practice Location Address Fax Number:
575-835-2216
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BHASKER
Authorized Official First Name:
ADDY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
575-835-2940

Provider Taxonomy Codes

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

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

  • Identifier: 44073 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201051377 . This is a "PREJB" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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