Healthcare Provider Details

I. General information

NPI: 1275801359
Provider Name (Legal Business Name): VISIONQUEST I-RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 YALE BLVD SE STE 301
ALBUQUERQUE NM
87106-4358
US

IV. Provider business mailing address

2501 YALE BLVD SE STE 301
ALBUQUERQUE NM
87106-4358
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-1994
  • Fax: 505-508-5308
Mailing address:
  • Phone: 505-508-1994
  • Fax: 505-508-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT RICHMOND
Title or Position: CFO
Credential:
Phone: 505-508-1994