MEDICARE: FOUR HUMOURS HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	2002-0281	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043376346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR HUMOURS HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	4304 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4811
Country	:	US
Telephone Number	:	505-888-1075
Fax Number	:	505-888-1082

Provider Business Practice Location Address
First Line	:	4304 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4811
Country	:	US
Telephone Number	:	505-888-1075
Fax Number	:	505-888-1082

Authorized Official
Title or Position	:	MEMBER
Name	:	LISA S NOYA
Credential	:	M.D.
Telephone Number	:	505-888-1075

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	03/01/2012

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