Healthcare Provider Details

I. General information

NPI: 1528407970
Provider Name (Legal Business Name): ABQ INJURY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 SAN MATEO BLVD NE SUITE 102
ALBUQUERQUE NM
87109-6299
US

IV. Provider business mailing address

5500 SAN MATEO BLVD NE SUITE 102
ALBUQUERQUE NM
87109-6299
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-4365
  • Fax: 505-884-4265
Mailing address:
  • Phone: 505-884-4365
  • Fax: 505-884-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH F WILSON
Title or Position: DOCTOR
Credential: D.C.
Phone: 505-884-4365