Healthcare Provider Details

I. General information

NPI: 1083053839
Provider Name (Legal Business Name): THE MEDIC GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 SAN MATEO BLVD NE
ALBUQUERQUE NM
87109-3533
US

IV. Provider business mailing address

PO BOX 66328
ALBUQUERQUE NM
87193-6328
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-9933
  • Fax: 505-792-7587
Mailing address:
  • Phone: 505-550-9933
  • Fax: 505-792-7587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number3804
License Number StateNM

VIII. Authorized Official

Name: MS. CONNIE STROMEI
Title or Position: OWNER
Credential:
Phone: 505-550-9933