MEDICARE: COTTONWOOD FAMILY MEDICINE LLC

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	CNP02459	NM

General Provider Information

NPI Number	:	1528429438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTONWOOD FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	10131 COORS BLVD NW STE H8
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4048
Country	:	US
Telephone Number	:	505-207-9044
Fax Number	:

Provider Business Practice Location Address
First Line	:	10131 COORS BLVD NW STE H8
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4048
Country	:	US
Telephone Number	:	505-207-9044
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATIE BOYLAN
Credential	:
Telephone Number	:	505-207-4099

Provider Enumeration Date	:	03/19/2016
Last Update Date	:	03/24/2026

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