Healthcare Provider Details

I. General information

NPI: 1497774574
Provider Name (Legal Business Name): INTERNAL MEDICINE OF GRANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GREENLEAF CT
GRANTS NM
87020-4235
US

IV. Provider business mailing address

101 GREENLEAF CT
GRANTS NM
87020-4235
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-2621
  • Fax: 505-287-5119
Mailing address:
  • Phone: 505-287-2621
  • Fax: 505-287-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2000-I38
License Number StateNM

VIII. Authorized Official

Name: DR. H N AUGENSTEIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 505-287-2621