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NPI Code Detail

MEDICARE: HENRY KOENIG PORTER

MEDICARE: HENRY KOENIG PORTER
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
1171M00000XCase Manager/Care CoordinatorNM

General Provider Information

NPI Number : 1437881638
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY KOENIG PORTER
Provider Business Mailing Address
First Line : 2301 YALE BLVD SE STE F
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-4354
Country : US
Telephone Number : 505-925-4044
Fax Number : 505-925-4354
Provider Business Practice Location Address
First Line : 2301 YALE BLVD SE STE F
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-4354
Country : US
Telephone Number : 505-925-4044
Fax Number : 505-925-4354
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2022
Last Update Date : 01/19/2026

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Directions to “ HENRY KOENIG PORTER ” Practice Location

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