Healthcare Provider Details

I. General information

NPI: 1376891762
Provider Name (Legal Business Name): NORTHWEST MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6463 4TH ST NW
LOS RANCHOS NM
87107-5810
US

IV. Provider business mailing address

6463 4TH ST NW
LOS RANCHOS NM
87107-5810
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-3572
  • Fax:
Mailing address:
  • Phone: 505-345-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA62474
License Number StateNM

VIII. Authorized Official

Name: DR. DON W. HEDGES
Title or Position: PRESIDENT
Credential: D.O.
Phone: 505-345-3572