# FOUR CORNERS HEART AND LUNG INSTITUTE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477859122
- **Authorized official:** DR. ROBERT FREDERICK SPRUNG MD (CEO)
- **Authorized official phone:** (801) 450-3851

## Contact information

- **Practice address:** 2700 FARMINGTON AVE, BUILDING I SUITE 2, FARMINGTON, NM 87401-4559
- **Practice address phone:** (505) 326-3691
- **Practice address fax:** (505) 327-9688
- **Mailing address:** 2700 FARMINGTON AVE, BUILDING I SUITE 2, FARMINGTON, NM 87401-4559
- **Mailing address phone:** (505) 326-3691
- **Mailing address fax:** (505) 327-9688

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | MD2008-0311 | NM | Yes |

## Other

- **Enumeration date:** 01/27/2011
- **Last updated:** 06/13/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 86532031 | — | NM |
| 01 | — | NM301033 | MEDICARE PTAN | NM |