Provider Demographics
NPI:1033547302
Name:HEALTH QUEST WELLNESS COTTONWOOD LLC
Entity Type:Organization
Organization Name:HEALTH QUEST WELLNESS COTTONWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-433-4646
Mailing Address - Street 1:PO BOX 92348
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-2348
Mailing Address - Country:US
Mailing Address - Phone:505-890-9355
Mailing Address - Fax:
Practice Address - Street 1:9664 EAGLE RANCH RD NW STE A-1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1578
Practice Address - Country:US
Practice Address - Phone:505-890-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2070261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1730484627OtherINDIVIDUAL NPI