Healthcare Provider Details

I. General information

NPI: 1275731606
Provider Name (Legal Business Name): QUICK FIX MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 SAN MATEO BLVD SE
ALBUQUERQUE NM
87108-3609
US

IV. Provider business mailing address

1035 SAN MATEO BLVD SE
ALBUQUERQUE NM
87108-3609
US

V. Phone/Fax

Practice location:
  • Phone: 505-254-9748
  • Fax: 505-255-0084
Mailing address:
  • Phone: 505-254-9748
  • Fax: 505-255-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberFA0037900
License Number StateNM

VIII. Authorized Official

Name: WILLIAM CHRIS GONZALES
Title or Position: OWNER
Credential:
Phone: 505-254-9748