Healthcare Provider Details

I. General information

NPI: 1356780597
Provider Name (Legal Business Name): HEALTH QUEST ALBUQUERQUE ACRES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 ALAMEDA BLVD NE SUITE 104E
ALBUQUERQUE NM
87122-3744
US

IV. Provider business mailing address

8650 ALAMEDA BLVD NE SUITE 104E
ALBUQUERQUE NM
87122-3744
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-7560
  • Fax: 505-323-7561
Mailing address:
  • Phone: 505-323-7560
  • Fax: 505-323-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number1754
License Number StateNM

VIII. Authorized Official

Name: DR. ALLEN R MINER
Title or Position: OWNER
Credential: DC
Phone: 505-463-9764