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General NPI Number Information
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NPI Number | 1316545882
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Entity Type | Organization
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Legal Business Name | KINGSLEY CLINIC OF NEW MEXICO, LLC
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 6300 RIVERSIDE PLAZA LN NW STE 100
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1908
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Country | US
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Telephone | 505-405-3617
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Fax | 505-370-2053
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Provider Business Mailing Address
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Address Line | 6300 RIVERSIDE PLAZA LN NW STE 100
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1908
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Country | US
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Telephone | 505-405-3617
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES KINGSLEY
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Credential | MD
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Telephone | 505-405-3617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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