Healthcare Provider Details

I. General information

NPI: 1366163677
Provider Name (Legal Business Name): WHOLE WOMAN'S HEALTH OF NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 LOMAS BLVD NW
ALBUQUERQUE NM
87102-2032
US

IV. Provider business mailing address

1001 E MARKET ST STE 200
CHARLOTTESVILLE VA
22902-5381
US

V. Phone/Fax

Practice location:
  • Phone: 434-422-2061
  • Fax: 210-881-6582
Mailing address:
  • Phone: 434-422-0216
  • Fax: 210-881-6582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA E SMITH
Title or Position: MEDICAL BILLING OPERATIONS MANAGER
Credential:
Phone: 434-422-2061