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Organization
FOUR CORNERS HEART AND LUNG INSTITUTE PC
Active
Organization
FOUR CORNERS HEART AND LUNG INSTITUTE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT FREDERICK SPRUNG MD (CEO)
(801) 450-3851
Entity
Organization
Contact information
Practice address
2700 FARMINGTON AVE, BUILDING I SUITE 2, FARMINGTON, NM 87401-4559
(505) 326-3691
(505) 327-9688
Mailing address
2700 FARMINGTON AVE, BUILDING I SUITE 2, FARMINGTON, NM 87401-4559
(505) 326-3691
(505) 327-9688
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
MD2008-0311
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86532031
—
NM
01
—
NM301033
MEDICARE PTAN
NM
Enumeration date
01/27/2011
Last updated
06/13/2011
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