1992191100 NPI number — LISA A PULSIPHER AUD LLC

Table of content: (NPI 1992191100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992191100 NPI number — LISA A PULSIPHER AUD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LISA A PULSIPHER AUD 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:
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:
1992191100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7007 WYOMING BLVD NE STE B4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-3982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-217-0912
Provider Business Mailing Address Fax Number:
505-217-0913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7007 WYOMING BLVD NE STE B4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-3982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-217-0912
Provider Business Practice Location Address Fax Number:
505-217-0913
Provider Enumeration Date:
04/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PULSIPHER
Authorized Official First Name:
LISA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
505-217-0912

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  5267 , 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: 95130039 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104179423 . This is a "PROVIDER NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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