Healthcare Provider Details

I. General information

NPI: 1194051748
Provider Name (Legal Business Name): STATMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 CARLISLE BLVD NE SUITE G
ALBUQUERQUE NM
87107-4556
US

IV. Provider business mailing address

3916 CARLISLE BLVD NE SUITE G
ALBUQUERQUE NM
87107-4556
US

V. Phone/Fax

Practice location:
  • Phone: 505-938-3990
  • Fax: 505-938-3993
Mailing address:
  • Phone: 505-938-3990
  • Fax: 505-938-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberFA0011499
License Number StateNM

VIII. Authorized Official

Name: DR. TORRE NEAR
Title or Position: CEO
Credential: M.D.
Phone: 505-938-3990