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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