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General NPI Number Information
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NPI Number | 1639275639
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Entity Type | Organization
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Legal Business Name | ALBUQUREQUE NEUROSCIENCE, INC.
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 101 HOSPITAL LOOP NE SUITE 209
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2129
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Country | US
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Telephone | 505-848-3773
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Fax | 505-848-3741
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Provider Business Mailing Address
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Address Line | 101 HOSPITAL LOOP NE SUITE 209
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2129
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Country | US
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Telephone | 505-848-3773
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Fax | 505-848-3741
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. GLENN MICHAEL DEMPSEY
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Credential | M.D.
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Telephone | 505-848-3773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744R1102X
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Taxonomy Name | Research Study Specialist
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License Number | 69126
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License Number State | NM
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