Healthcare Provider Details

I. General information

NPI: 1467691022
Provider Name (Legal Business Name): ALBUQUERQUE NEUROSCIENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LOOP NE SUITE 209
ALBUQUERQUE NM
87109-2129
US

IV. Provider business mailing address

101 HOSPITAL LOOP NE SUITE 209
ALBUQUERQUE NM
87109-2129
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-3773
  • Fax: 505-848-3741
Mailing address:
  • Phone: 505-848-3773
  • Fax: 505-848-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number69-126
License Number StateNM

VIII. Authorized Official

Name: DR. GLENN MICHAEL DEMPSEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-848-3773