MEDICARE: DUKE CITY OCCUPATIONAL 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	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1104527514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUKE CITY OCCUPATIONAL HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	11505 MONTGOMERY BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2703
Country	:	US
Telephone Number	:	505-228-2108
Fax Number	:

Provider Business Practice Location Address
First Line	:	3121 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1654
Country	:	US
Telephone Number	:	505-228-2108
Fax Number	:	505-205-1514

Authorized Official
Title or Position	:	CEO
Name	:	EDWARD H TALIAFERRO
Credential	:	MD
Telephone Number	:	505-238-6757

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	08/14/2024

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