Healthcare Provider Details

I. General information

NPI: 1326188715
Provider Name (Legal Business Name): NORTHWEST MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6463 4TH ST NW
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

6463 4TH ST NW
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-3572
  • Fax: 505-345-5889
Mailing address:
  • Phone: 505-345-3572
  • Fax: 505-345-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DON W HODGES
Title or Position: PRESIDENT
Credential: DO
Phone: 505-345-3572