Healthcare Provider Details

I. General information

NPI: 1669506994
Provider Name (Legal Business Name): ACCENT ON HEALTH MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/29/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 HILLRISE DRIVE 2900 HILLRISE DRIVE
LAS CRUCES NM
88011
US

IV. Provider business mailing address

1180 COMMERCE DRIVE #14222
LAS CRUCES NM
88011-8255
US

V. Phone/Fax

Practice location:
  • Phone: 505-695-1227
  • Fax: 877-532-2113
Mailing address:
  • Phone: 505-695-1227
  • Fax: 877-532-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GLENN J WALDT
Title or Position: OWNER
Credential: DO
Phone: 505-695-1227