Provider Demographics
NPI:1417007055
Name:KLINGLER, PATRICK T (SOLE PROPRIETOR)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:T
Last Name:KLINGLER
Suffix:
Gender:M
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4333
Mailing Address - Country:US
Mailing Address - Phone:505-762-3524
Mailing Address - Fax:505-762-3523
Practice Address - Street 1:128 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4333
Practice Address - Country:US
Practice Address - Phone:505-762-3524
Practice Address - Fax:505-762-3523
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76877329Medicaid
NM76877329Medicaid