Healthcare Provider Details

I. General information

NPI: 1669285409
Provider Name (Legal Business Name): INDIGO SUN PALLIATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4273 MONTGOMERY BLVD NE STE 110
ALBUQUERQUE NM
87109-6746
US

IV. Provider business mailing address

4273 MONTGOMERY BLVD NE STE 110
ALBUQUERQUE NM
87109-6746
US

V. Phone/Fax

Practice location:
  • Phone: 505-365-0321
  • Fax: 505-520-0131
Mailing address:
  • Phone: 505-365-0321
  • Fax: 505-520-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA HOLLINGSWORTH
Title or Position: BOARD MEMBER
Credential: RN
Phone: 505-365-0321