Healthcare Provider Details

I. General information

NPI: 1508155631
Provider Name (Legal Business Name): AFFILION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E 19TH ST
ROSWELL NM
88201-5151
US

IV. Provider business mailing address

80 E RIO SALADO PKWY SUITE 703
TEMPE AZ
85281-9103
US

V. Phone/Fax

Practice location:
  • Phone: 575-627-7000
  • Fax: 575-627-7007
Mailing address:
  • Phone: 480-247-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNM

VIII. Authorized Official

Name: DAVID SAMUELS
Title or Position: PRESIDENT
Credential:
Phone: 480-247-9195