1023346350 NPI number — NEW MEXICO NURSE, LLC.

Table of content: (NPI 1023346350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023346350 NPI number — NEW MEXICO NURSE, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MEXICO NURSE, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROUTE 66 MEDICAL STAFFING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023346350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5010 CUTLER AVE NE
Provider Second Line Business Mailing Address:
STE. D2-180
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-4084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-508-1881
Provider Business Mailing Address Fax Number:
505-508-1909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3939 SAN PEDRO DR NE
Provider Second Line Business Practice Location Address:
BLDG. C
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-508-1881
Provider Business Practice Location Address Fax Number:
505-508-1909
Provider Enumeration Date:
11/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MORRISS
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
505-508-1881

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  FA0066866 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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