Provider Demographics
NPI:1093812521
Name:ALAMOGORDO CLINIC LTD
Entity Type:Organization
Organization Name:ALAMOGORDO CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:ADAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-437-7000
Mailing Address - Street 1:1410 ASPEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310
Mailing Address - Country:US
Mailing Address - Phone:505-437-7000
Mailing Address - Fax:505-434-6288
Practice Address - Street 1:1410 ASPEN DRIVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:505-437-7000
Practice Address - Fax:505-434-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM87-1261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ3128Medicaid
NMQ3128Medicaid