Organization
GRAND SUMMIT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BAKHTAR EHSAN (CFO)
(831) 325-3541
Entity
Organization
Contact information
Practice address
13207 CENTRAL AVE NE, ALBUQUERQUE, NM 87123-3033
(505) 595-1607
Mailing address
9909 ROBIN AVE NE, ALBUQUERQUE, NM 87112-4061
(505) 274-3556
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
261QM2800X
Methadone Clinic
Primary
—
—
Other
Enumeration date
12/02/2024
Last updated
05/20/2025
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