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General NPI Number Information
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NPI Number | 1790507531
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Entity Type | Organization
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Legal Business Name | HEARTLAND CLINICS OF NEW MEXICO, INC
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 609 BROADWAY BLVD NE # 100
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-9804
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Country | US
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Telephone | 904-207-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 667 BARTRAM DOWNS RD # 667
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City | ORANGE PARK
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State | FL
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Zip | 32065-8231
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Country | US
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Telephone | 904-207-4224
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. STEPHEN A DAY
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Credential |
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Telephone | 904-207-4224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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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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