Basic Information
| Provider Information | |||||||||
| NPI: | 1447575832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRESBYTARIAN HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94204 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871994204 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 CENTRAL AVE SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058411234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2010 | ||||||||
| LastUpdateDate: | 03/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | BORNAEI | ||||||||
| AuthorizedOfficialFirstName: | MARYAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | NP | ||||||||
| AuthorizedOfficialTelephone: | 5053192914 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | R47576 | NM | Y | Hospitals | General Acute Care Hospital |
No ID Information.