Healthcare Provider Details

I. General information

NPI: 1346960374
Provider Name (Legal Business Name): HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4373 ALEXANDER BLVD NE
ALBUQUERQUE NM
87107-6802
US

IV. Provider business mailing address

4373 ALEXANDER BLVD NE
ALBUQUERQUE NM
87107-6802
US

V. Phone/Fax

Practice location:
  • Phone: 312-653-7754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: NORMA GUAJARDO
Title or Position: PROCESS CONSULTANT II
Credential:
Phone: 312-653-7754