Healthcare Provider Details

I. General information

NPI: 1063741163
Provider Name (Legal Business Name): AZTEC URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S RIO GRANDE AVE
AZTEC NM
87410-2260
US

IV. Provider business mailing address

2577 MAIN AVE
DURANGO CO
81301-5919
US

V. Phone/Fax

Practice location:
  • Phone: 505-334-2664
  • Fax: 505-334-7759
Mailing address:
  • Phone: 970-247-8382
  • Fax: 970-259-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN VINCENT
Title or Position: PRESIDENT
Credential:
Phone: 970-247-8382