Provider Demographics
NPI:1598879652
Name:PINON FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:PINON FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-324-1000
Mailing Address - Street 1:2300 E 30TH ST
Mailing Address - Street 2:BLDG C-2
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8990
Mailing Address - Country:US
Mailing Address - Phone:505-324-1000
Mailing Address - Fax:505-324-1199
Practice Address - Street 1:2300 E 30TH ST
Practice Address - Street 2:BLDG C-2
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8990
Practice Address - Country:US
Practice Address - Phone:505-324-1000
Practice Address - Fax:505-324-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ7265Medicaid
32D0943693OtherCLIA NUMBER
CG6367OtherRAILROAD RETIRE CLINIC ID
=========OtherEIN
CG6367OtherRAILROAD RETIRE CLINIC ID