Healthcare Provider Details

I. General information

NPI: 1043541626
Provider Name (Legal Business Name): TADDY HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W MERMOD ST
CARLSBAD NM
88220-4912
US

IV. Provider business mailing address

615 W MERMOD ST
CARLSBAD NM
88220-3513
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-7714
  • Fax: 575-885-7714
Mailing address:
  • Phone: 575-885-7714
  • Fax: 575-885-7714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-1299-05
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA-1299-05
License Number StateNM

VIII. Authorized Official

Name: DR. NII TETTEH TSURU ADDY
Title or Position: PRESIDENT
Credential: D.O
Phone: 989-482-1002