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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