=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275731606
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUICK FIX MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1035 SAN MATEO BLVD SE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87108-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-254-9748
-----------------------------------------------------
Fax | 505-255-0084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1035 SAN MATEO BLVD SE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87108-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-254-9748
-----------------------------------------------------
Fax | 505-255-0084
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM CHRIS GONZALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-254-9748
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | FA0037900
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------