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General NPI Number Information
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NPI Number | 1477859122
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Entity Type | Organization
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Legal Business Name | FOUR CORNERS HEART AND LUNG INSTITUTE PC
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 2700 FARMINGTON AVE BUILDING I SUITE 2
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City | FARMINGTON
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State | NM
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Zip | 87401-4559
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Country | US
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Telephone | 505-326-3691
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Fax | 505-327-9688
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Provider Business Mailing Address
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Address Line | 2700 FARMINGTON AVE BUILDING I SUITE 2
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City | FARMINGTON
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State | NM
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Zip | 87401-4559
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Country | US
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Telephone | 505-326-3691
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Fax | 505-327-9688
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Authorized Official
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Title or Position | CEO
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Name | DR. ROBERT FREDERICK SPRUNG
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Credential | MD
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Telephone | 801-450-3851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD2008-0311
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License Number State | NM
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