Basic Information
| Provider Information | |||||||||
| NPI: | 1386014769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NM 01 PALLIATIVE CARE SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3544 E 17TH ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | AMMON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834066911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085240685 | ||||||||
| FaxNumber: | 2085240686 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 LANG AVE NE | ||||||||
| Address2: | SUITE 200A | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058425460 | ||||||||
| FaxNumber: | 5058425466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2015 | ||||||||
| LastUpdateDate: | 09/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING EMPLOYEE | ||||||||
| AuthorizedOfficialTelephone: | 5058425460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | Y | Agencies | In Home Supportive Care |
No ID Information.