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General NPI Number Information
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NPI Number | 1699517771
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Entity Type | Organization
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Legal Business Name | SPECIALTY CARE CLINIC LLC
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Dates
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Enumeration Date | 06/10/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 3825 EUBANK BLVD NE STE H
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3559
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Country | US
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Telephone | 505-350-3397
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Fax | 505-323-7980
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Provider Business Mailing Address
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Address Line | 3825 EUBANK BLVD NE STE H
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3559
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Country | US
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Telephone | 505-350-3397
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Fax | 505-323-7980
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Authorized Official
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Title or Position | OWNER CEO
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Name | MR. JOHN K JAIN
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Credential |
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Telephone | 505-350-3397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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