Healthcare Provider Details

I. General information

NPI: 1104468602
Provider Name (Legal Business Name): PRESBYTERIAN HOSPITAL ASC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST, SUITE 7650
ALBUQUERQUE NM
87106-4911
US

IV. Provider business mailing address

201 CEDAR ST, SUITE 7650
ALBUQUERQUE NM
87106-4911
US

V. Phone/Fax

Practice location:
  • Phone: 505-357-3554
  • Fax:
Mailing address:
  • Phone: 505-357-3554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC BOON
Title or Position: OFFICER/AO
Credential:
Phone: 480-567-0269