Healthcare Provider Details

I. General information

NPI: 1790185577
Provider Name (Legal Business Name): DUKE CITY URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2660
US

IV. Provider business mailing address

11601 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2660
US

V. Phone/Fax

Practice location:
  • Phone: 505-207-3421
  • Fax: 505-702-8171
Mailing address:
  • Phone: 505-207-3421
  • Fax: 505-702-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberMD2004-0796
License Number StateNM

VIII. Authorized Official

Name: DR. EDWARD H TALIAFERRO IV
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-238-6757