Healthcare Provider Details

I. General information

NPI: 1467841064
Provider Name (Legal Business Name): MD HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-5813
US

IV. Provider business mailing address

5201 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-5813
US

V. Phone/Fax

Practice location:
  • Phone: 505-633-8620
  • Fax: 505-633-8619
Mailing address:
  • Phone: 505-633-8620
  • Fax: 505-633-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GWEN A SAYLER
Title or Position: ACCOUNTANT
Credential:
Phone: 505-633-8620