Healthcare Provider Details

I. General information

NPI: 1366740086
Provider Name (Legal Business Name): MARK ALAN REID RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11216 NASSAU DR NE
ALBUQUERQUE NM
87111-2655
US

IV. Provider business mailing address

11216 NASSAU DR NE
ALBUQUERQUE NM
87111-2655
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-4463
  • Fax: 505-294-4250
Mailing address:
  • Phone: 505-294-4463
  • Fax: 505-294-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278P3800X
TaxonomyPalliative/Hospice Certified Respiratory Therapist
License Number716
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License Number716
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2278P4000X
TaxonomyPatient Transport Certified Respiratory Therapist
License Number716
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number716
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number716
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License Number716
License Number StateNM
# 7
Primary TaxonomyN
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number716
License Number StateNM
# 8
Primary TaxonomyN
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number716
License Number StateNM
# 9
Primary TaxonomyN
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number716
License Number StateNM
# 10
Primary TaxonomyN
Taxonomy Code2279S1500X
TaxonomySNF/Subacute Care Registered Respiratory Therapist
License Number716
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: