Healthcare Provider Details

I. General information

NPI: 1578005484
Provider Name (Legal Business Name): NORTHVIEW FAMILY PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 LOUISIANA BLVD NE SUITE A
ALBUQUERQUE NM
87113-2103
US

IV. Provider business mailing address

PO BOX 10777
ALBUQUERQUE NM
87184-0777
US

V. Phone/Fax

Practice location:
  • Phone: 505-554-2409
  • Fax: 505-554-2876
Mailing address:
  • Phone: 505-554-2409
  • Fax: 505-554-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2013-0554
License Number StateNM

VIII. Authorized Official

Name: CHERI A BLACKSTEN
Title or Position: PRESIDENT
Credential: MD
Phone: 505-554-2409