Healthcare Provider Details

I. General information

NPI: 1801338231
Provider Name (Legal Business Name): ALBUQUERQUE INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1102
US

IV. Provider business mailing address

PO BOX 25782
ALBUQUERQUE NM
87125-0782
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-8962
  • Fax: 505-503-8955
Mailing address:
  • Phone: 505-503-8962
  • Fax: 505-503-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVAN SCHERR
Title or Position: MANAGING PARTNER
Credential:
Phone: 505-503-8962