MEDICARE: KURT SIMMONS

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1407062938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURT SIMMONS

Provider Business Mailing Address
First Line	:	PO BOX 8322
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87198-8322
Country	:	US
Telephone Number	:	505-238-8233
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 SAN PEDRO DR NE
Second Line	:	SUITE C
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4119
Country	:	US
Telephone Number	:	505-238-8233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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Directions to “ KURT SIMMONS ” Practice Location

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