1881767366 NPI number — CYFD-STATE OF NEW MEXICO-CARLSBAD CRF

Table of content: (NPI 1881767366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881767366 NPI number — CYFD-STATE OF NEW MEXICO-CARLSBAD CRF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYFD-STATE OF NEW MEXICO-CARLSBAD CRF
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:
6
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:
1881767366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SAN MATEO BLVD NE STE 410
Provider Second Line Business Mailing Address:
300 SAN MATEO BLVD, NE, SUITE 410
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87108-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-841-6372
Provider Business Mailing Address Fax Number:
505-841-2949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 N MESQUITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88220-4960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-885-8781
Provider Business Practice Location Address Fax Number:
505-885-8683
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
MINOR
Authorized Official Middle Name:
Authorized Official Title or Position:
BUREAU CHIEF, CYFDJJS ENTITLEMENT
Authorized Official Telephone Number:
505-841-6372

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  7275 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NM600533VNM00239NO . This is a "VALUE OPTIONS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: H1847 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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