Healthcare Provider Details

I. General information

NPI: 1891010369
Provider Name (Legal Business Name): MONITORED MEDICAL LCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 CENTRAL AVE SE
ALBUQUERQUE NM
87123-2728
US

IV. Provider business mailing address

13170 CENTRAL AVE. SE STE B #B309
ALBUQUERQUE NM
87123-5504
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-6007
  • Fax: 505-889-0641
Mailing address:
  • Phone: 505-275-6007
  • Fax: 505-889-0641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number03169090004
License Number StateNM

VIII. Authorized Official

Name: MR. MICHAEL CALDWELL
Title or Position: PRESIDENT
Credential:
Phone: 505-275-6007