1083635106 NPI number — CLAUDE D GELINAS MD PC

Table of content: (NPI 1083635106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083635106 NPI number — CLAUDE D GELINAS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAUDE D GELINAS MD PC
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:
Provider Other Organization Name Type Code:
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:
1083635106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 JEFFERSON ST NE
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-4379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-242-1711
Provider Business Mailing Address Fax Number:
505-242-0189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 JEFFERSON ST NE
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-4379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-242-1711
Provider Business Practice Location Address Fax Number:
505-242-0291
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
CANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
505-242-1711

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  97245 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , with the licence number: 97245 , 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)

  • Identifier: Q0095 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com