Organization
NEW MEXICO MIGRAINE CLINIC LLC
Active
Organization
NEW MEXICO MIGRAINE CLINIC LLC
Active
Other names
New Mexico Migraine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONAH FOUTZ (MEMBER)
(505) 926-1767
Entity
Organization
Contact information
Practice address
2901 JUAN TABO BLVD NE STE 10, ALBUQUERQUE, NM 87112-1885
(505) 926-1767
Mailing address
100 ROME LN, CORRALES, NM 87048-9006
(505) 926-1767
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
DD3662
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47989050
—
NM
Enumeration date
02/15/2018
Last updated
02/15/2018
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