=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891851010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPANDING CHOICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 01/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6100 UPTOWN BLVD NE STE 650
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110-4186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-340-0700
-----------------------------------------------------
Fax | 505-340-0701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6100 UPTOWN BLVD NE STE 650
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110-4186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-340-0700
-----------------------------------------------------
Fax | 505-340-0701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK HENRY RATERINK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 505-340-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 2002-0271
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------