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Organization

NEW MEXICO DEPARTMENT OF HEALTH

Active
Parent organization
STATE OF NEW MEXICO, DOH, DDSD, ASB
Other names
Specialty Seating Clinic
Organization subpart
Yes

Provider details

NPI number
Legal business name
STATE OF NEW MEXICO, DOH, DDSD, ASB
Authorized official
SCOTT GIFFORD (LINE II MANAGER)
(505) 232-5712
Entity
Organization

Contact information

Practice address
7905 MARBLE AVE NE, ALBUQUERQUE, NM 87110-7886
(505) 222-0900
(505) 222-0933
Mailing address
7905 MARBLE AVE NE, ALBUQUERQUE, NM 87110-7886
(505) 232-5712
(505) 222-0933

Taxonomy

Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000D1977
NM
Enumeration date
12/12/2006
Last updated
04/04/2018
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