Basic Information
| Provider Information | |||||||||
| NPI: | 1437147899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EAVES | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CRAIG | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RPSGT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 6500 JEFFERSON ST NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871093489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058438758 | ||||||||
| FaxNumber: | 5058438759 | ||||||||
| Practice Location | |||||||||
| Address1: | 3810 MASTHEAD ST NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058438758 | ||||||||
| FaxNumber: | 5058438759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 12/11/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 92-278 | NM | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 225500000X | 2581 | NM | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | 227800000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | 227900000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | 246Z00000X | 2581 | NM | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other |
ID Information
| ID | Type | State | Issuer | Description | 95877321 | 05 | NM | MEDICAID | 81323395 | 05 | NM | MEDICAID |