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General NPI Number Information
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NPI Number | 1659093961
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Entity Type | Organization
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Legal Business Name | ASCENT MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 2055 S PACHECO ST STE 600
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City | SANTA FE
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State | NM
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Zip | 87505-3995
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Country | US
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Telephone | 505-930-5065
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Fax |
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Provider Business Mailing Address
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Address Line | 2055 S PACHECO ST STE 600
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City | SANTA FE
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State | NM
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Zip | 87505-3995
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Country | US
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Telephone | 303-579-5466
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. BRIAN MATHWICH SR.
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Credential | MD
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Telephone | 303-579-5466
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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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