Organization
RIO WEST MEDICAL, LLC
Active
Other names
Roadrunner Footwear and Footcare
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA YAUK C PED (OWNER)
(505) 896-0533
Entity
Organization
Contact information
Practice address
6200 COORS BLVD NW, ALBUQUERQUE, NM 87120-2785
(505) 896-0533
(505) 896-0522
Mailing address
PO BOX 44787, RIO RANCHO, NM 87174-4787
(505) 896-0533
(505) 896-0522
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06587577
—
NM
05
—
06928773
—
NM
01
—
201065393
PRESBYTERIAN NM
NM
01
—
202003149
PRESBYTERIAN NM
NM
01
—
NM01TA20
BCBSNM
NM
Enumeration date
03/23/2006
Last updated
11/14/2008
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