1881071462 NPI number — YOUR HEALTH FIRST MEDICAL CLINIC, LLC

Table of content: (NPI 1881071462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881071462 NPI number — YOUR HEALTH FIRST MEDICAL CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUR HEALTH FIRST MEDICAL CLINIC, 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:
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:
1881071462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 832
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87701-0832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-429-9440
Provider Business Mailing Address Fax Number:
949-437-3906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87701-4221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-398-1160
Provider Business Practice Location Address Fax Number:
949-437-3906
Provider Enumeration Date:
05/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OSUCHOWSKI-SANCHEZ
Authorized Official First Name:
MARY ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-398-1160

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  CNP00739 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com