Healthcare Provider Details

I. General information

NPI: 1194886499
Provider Name (Legal Business Name): NEW MEXICO DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 MARBLE AVE NE
ALBUQUERQUE NM
87110-7886
US

IV. Provider business mailing address

7905 MARBLE AVE NE
ALBUQUERQUE NM
87110-7886
US

V. Phone/Fax

Practice location:
  • Phone: 505-222-0900
  • Fax: 505-222-0933
Mailing address:
  • Phone: 505-232-5712
  • Fax: 505-222-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SCOTT GIFFORD
Title or Position: LINE II MANAGER
Credential:
Phone: 505-232-5712