Healthcare Provider Details

I. General information

NPI: 1740646611
Provider Name (Legal Business Name): M D INJURY RELIEF CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 CANDELARIA RD NE STE K
ALBUQUERQUE NM
87107-1952
US

IV. Provider business mailing address

3311 CANDELARIA RD NE STE K
ALBUQUERQUE NM
87107-1952
US

V. Phone/Fax

Practice location:
  • Phone: 505-246-9190
  • Fax:
Mailing address:
  • Phone: 505-246-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS WHALEN
Title or Position: OWNER
Credential:
Phone: 505-246-9190