# RIO GRANDE INTERNAL MEDICINE PC

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

## Provider details

- **NPI number:** 1750688032
- **Authorized official:** DR. KEVIN J GOODLUCK MD (PRESIDENT)
- **Authorized official phone:** (505) 792-2636

## Contact information

- **Practice address:** 4801 MCMAHON BLVD NW, SUITE 235, ALBUQUERQUE, NM 87114-5090
- **Practice address phone:** (505) 792-2636
- **Practice address fax:** (505) 234-1707
- **Mailing address:** 4801 MCMAHON BLVD NW, SUITE 235, ALBUQUERQUE, NM 87114-5090
- **Mailing address phone:** (505) 792-2636
- **Mailing address fax:** (505) 234-1707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 97251 | NM | Yes |

## Other

- **Enumeration date:** 02/22/2011
- **Last updated:** 10/19/2011