Basic Information
| Provider Information | |||||||||
| NPI: | 1154350205 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAOS CLINIC FOR CHILDREN AND YOUTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1393 WEIMER ROAD | ||||||||
| Address2: | |||||||||
| City: | TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875716253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757588651 | ||||||||
| FaxNumber: | 5757587811 | ||||||||
| Practice Location | |||||||||
| Address1: | 1393 WEIMER RD | ||||||||
| Address2: | |||||||||
| City: | TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875716253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757588651 | ||||||||
| FaxNumber: | 5757587811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 05/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | SCHLARBAUM | ||||||||
| AuthorizedOfficialFirstName: | DICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5757588651 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.