Healthcare Provider Details

I. General information

NPI: 1134487952
Provider Name (Legal Business Name): MEDICAL MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 ACADEMY RD NE SUITE 390
ALBUQUERQUE NM
87111-1229
US

IV. Provider business mailing address

10400 ACADEMY RD NE SUITE 390
ALBUQUERQUE NM
87111-1229
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-4444
  • Fax: 505-323-2222
Mailing address:
  • Phone: 505-294-4444
  • Fax: 505-323-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCNP-01687
License Number StateNM

VIII. Authorized Official

Name: MS. JACQUELYN P REEVE
Title or Position: PRESIDENT
Credential: CNP
Phone: 505-924-4444