Healthcare Provider Details

I. General information

NPI: 1508339276
Provider Name (Legal Business Name): ALAMEDA ACUTE CARE CLINIC AND FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2019
Last Update Date: 03/23/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 ALAMEDA BLVD NW STE C
ALBUQUERQUE NM
87114-1953
US

IV. Provider business mailing address

1111 ALAMEDA BLVD NW STE C
ALBUQUERQUE NM
87114-1953
US

V. Phone/Fax

Practice location:
  • Phone: 505-346-3704
  • Fax: 505-212-0859
Mailing address:
  • Phone: 505-346-3704
  • Fax: 505-387-3937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PISETH KNIGHT
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 505-346-3704