MEDICARE: ST. CHRISTOPHER INC

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	261QP2300X	Primary Care Clinic/Center	03079971006	NM

General Provider Information

NPI Number	:	1356405369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. CHRISTOPHER INC

Provider Business Mailing Address
First Line	:	2800 SAN MATEO BLVD NE
Second Line	:	SUITE 107
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3135
Country	:	US
Telephone Number	:	505-821-1146
Fax Number	:	505-843-9234

Provider Business Practice Location Address
First Line	:	2800 SAN MATEO BLVD NE
Second Line	:	SUITE 107
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3135
Country	:	US
Telephone Number	:	505-821-1146
Fax Number	:	505-843-9234

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER K TIERNAN
Credential	:	M.D.
Telephone Number	:	505-821-1146

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/21/2010

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Directions to “ST. CHRISTOPHER INC ” Practice Location

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