MEDICARE: DR. ANN EDMUNDS HEATH MD

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	207Q00000X	Family Medicine Physician	2001-212	NM

General Provider Information

NPI Number	:	1174730154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN EDMUNDS HEATH MD

Provider Business Mailing Address
First Line	:	1217 BONITA ST
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2103
Country	:	US
Telephone Number	:	505-287-2950
Fax Number	:	505-287-2403

Provider Business Practice Location Address
First Line	:	1217 BONITA ST
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2103
Country	:	US
Telephone Number	:	505-287-2950
Fax Number	:	505-287-2403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/17/2015

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Directions to “ DR. ANN EDMUNDS HEATH MD” Practice Location

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