Healthcare Provider Details

I. General information

NPI: 1013244995
Provider Name (Legal Business Name): MEDICAL CONSULTING MEDIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 ALVARADO DR SE
ALBUQUERQUE NM
87108-2940
US

IV. Provider business mailing address

908 POCO CERRO CT SE
ALBUQUERQUE NM
87123-4193
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-1700
  • Fax:
Mailing address:
  • Phone: 505-323-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DONALD DEANE DOTY JR.
Title or Position: VICE PRESIDENT
Credential: CPO
Phone: 505-323-8187