Healthcare Provider Details

I. General information

NPI: 1720336449
Provider Name (Legal Business Name): ROBERT M GROTHE EMTP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EUBANK BLVD SE BLDG 831832
ALBUQUERQUE NM
87123-3453
US

IV. Provider business mailing address

1515 EUBANK BLVD SE BLDG 831832
ALBUQUERQUE NM
87123-3453
US

V. Phone/Fax

Practice location:
  • Phone: 505-844-4237
  • Fax:
Mailing address:
  • Phone: 505-844-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number00021074
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: