Healthcare Provider Details

I. General information

NPI: 1689795635
Provider Name (Legal Business Name): EECP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

502 ELM ST NE
ALBUQUERQUE NM
87102-2512
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1000
  • Fax: 505-843-2956
Mailing address:
  • Phone: 505-841-1000
  • Fax: 505-843-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number83-312
License Number StateNM

VIII. Authorized Official

Name: DR. R BRAD STAMM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 505-841-1000