Organization
PRIMARY CARE AND PREVENTIVE SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW C BRYANT (OFFICE MANAGER)
(505) 883-1259
Entity
Organization
Contact information
Practice address
4710 JEFFERSON ST NE, ALBUQUERQUE, NM 87109-2155
(505) 883-1259
(505) 883-3020
Mailing address
4710 JEFFERSON ST NE, ALBUQUERQUE, NM 87109-2155
(505) 883-1259
(505) 883-3020
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
86-185
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202006617
PRESBYTERIAN PIN
NM
01
—
975291
UNITED HEALTHCARE PIN
NM
Enumeration date
06/07/2006
Last updated
02/27/2014
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