MEDICARE: CHARLES F PACE MD

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	207L00000X	Anesthesiology Physician	2000-259	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM009L89	OTHER	NM	BCBS
2	201048060	OTHER	NM	PRESBYTERIAN HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922190040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES F PACE MD

Provider Business Mailing Address
First Line	:	4824 MCMAHON BLVD NW
Second Line	:	SUITE 119
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5412
Country	:	US
Telephone Number	:	505-898-1595
Fax Number	:	505-898-0846

Provider Business Practice Location Address
First Line	:	4824 MCMAHON BLVD NW
Second Line	:	SUITE 119
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5412
Country	:	US
Telephone Number	:	505-898-1595
Fax Number	:	505-898-0846

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/24/2023

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Directions to “ CHARLES F PACE MD” Practice Location

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