Provider Demographics
NPI:1548404825
Name:AMIR H. MANOUTCHEHRI M.D. PC
Entity Type:Organization
Organization Name:AMIR H. MANOUTCHEHRI M.D. PC
Other - Org Name:PINERIDGE-URGENT CARE & MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:MANOUTCHEHRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:505-407-2174
Mailing Address - Street 1:12125 STATE HIGHWAY 14 N.
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008
Mailing Address - Country:US
Mailing Address - Phone:505-407-2174
Mailing Address - Fax:505-890-7944
Practice Address - Street 1:12125 STATE HIGHWAY 14 N.
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008
Practice Address - Country:US
Practice Address - Phone:505-407-2174
Practice Address - Fax:505-407-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM87108207P00000X, 261QP2300X, 261QU0200X
NM87-108261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA100560Medicare PIN
NME42476Medicare UPIN
NMNMA100560Medicare PIN