Healthcare Provider Details

I. General information

NPI: 1245559368
Provider Name (Legal Business Name): ONCALL IMMEDAITE MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 SAINT MICHAELS DR SUITE B
SANTA FE NM
87505-8607
US

IV. Provider business mailing address

PO BOX 3020
ALBUQUERQUE NM
87190-3020
US

V. Phone/Fax

Practice location:
  • Phone: 505-954-9949
  • Fax: 505-986-0008
Mailing address:
  • Phone: 505-954-9949
  • Fax: 505-969-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1000095012
License Number StateNM

VIII. Authorized Official

Name: DWIGHT C LOPEZ
Title or Position: CEO ADMINISTRATOR
Credential:
Phone: 505-954-9949