Provider Demographics
NPI:1508510199
Name:NEW MEXICO URGENT CARE WALK-IN CLINIC JUAN TABO LLC
Entity Type:Organization
Organization Name:NEW MEXICO URGENT CARE WALK-IN CLINIC JUAN TABO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:NAEEM
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-890-4627
Mailing Address - Street 1:10820 COMANCHE RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3983
Mailing Address - Country:US
Mailing Address - Phone:505-508-4068
Mailing Address - Fax:505-554-1817
Practice Address - Street 1:10820 COMANCHE RD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3983
Practice Address - Country:US
Practice Address - Phone:505-508-4068
Practice Address - Fax:505-554-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care