Healthcare Provider Details

I. General information

NPI: 1508510199
Provider Name (Legal Business Name): NEW MEXICO URGENT CARE WALK-IN CLINIC JUAN TABO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 COMANCHE RD NE STE A
ALBUQUERQUE NM
87111-3983
US

IV. Provider business mailing address

10820 COMANCHE RD NE STE A
ALBUQUERQUE NM
87111-3983
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-4068
  • Fax: 505-554-1817
Mailing address:
  • Phone: 505-508-4068
  • Fax: 505-554-1817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MUHAMMAD NAEEM AHMAD
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 734-890-4627