Provider Demographics
NPI:1619052107
Name:DIRECT HEALTTHCARE
Entity Type:Organization
Organization Name:DIRECT HEALTTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-425-7471
Mailing Address - Street 1:5412 SULTAN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-8932
Mailing Address - Country:US
Mailing Address - Phone:505-429-4566
Mailing Address - Fax:505-425-6477
Practice Address - Street 1:5412 SULTAN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-8932
Practice Address - Country:US
Practice Address - Phone:505-425-7471
Practice Address - Fax:505-425-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCRS02424726000302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29857309Medicaid
NM19234287Medicaid