MEDICARE: FAMILY MEDICINE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083802029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE PC

Provider Business Mailing Address
First Line	:	3825 EUBANK BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3575
Country	:	US
Telephone Number	:	505-292-8575
Fax Number	:	505-292-8409

Provider Business Practice Location Address
First Line	:	3825 EUBANK BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3559
Country	:	US
Telephone Number	:	505-292-8575
Fax Number	:	505-292-8409

Authorized Official
Title or Position	:	CHIEF BUSINESS OFFICER
Name	:	STEPHANIE HENDERSON
Credential	:
Telephone Number	:	505-494-5400

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	06/18/2024

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Directions to “FAMILY MEDICINE PC ” Practice Location

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