Healthcare Provider Details

I. General information

NPI: 1174754808
Provider Name (Legal Business Name): EAGLES UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 5TH ST NW
ALBUQUERQUE NM
87102-2141
US

IV. Provider business mailing address

PO BOX 27302
ALBUQUERQUE NM
87125-7302
US

V. Phone/Fax

Practice location:
  • Phone: 505-254-7600
  • Fax: 505-254-7707
Mailing address:
  • Phone: 505-254-7600
  • Fax: 505-254-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL C COLLINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-254-7600