Provider Demographics
NPI:1245559368
Name:ONCALL IMMEDAITE MEDICAL CARE LLC
Entity Type:Organization
Organization Name:ONCALL IMMEDAITE MEDICAL CARE LLC
Other - Org Name:ONCALL IMMEDIATE MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-954-9949
Mailing Address - Street 1:PO BOX 3020
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87190-3020
Mailing Address - Country:US
Mailing Address - Phone:505-954-9949
Mailing Address - Fax:505-969-0008
Practice Address - Street 1:431 SAINT MICHAELS DR
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-8607
Practice Address - Country:US
Practice Address - Phone:505-954-9949
Practice Address - Fax:505-986-0008
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONCALL IMMEDIATE MEDICAL CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1000095012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM40052155Medicare PIN