Healthcare Provider Details

I. General information

NPI: 1679117352
Provider Name (Legal Business Name): STEVENS MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7123 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

IV. Provider business mailing address

7123 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-6331
  • Fax: 505-298-0037
Mailing address:
  • Phone: 505-299-6331
  • Fax: 505-298-0037

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: DANA TUMA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 505-299-6331