Provider Demographics
NPI:1619113032
Name:DOCTOR ON CALL, LLC #2
Entity Type:Organization
Organization Name:DOCTOR ON CALL, LLC #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-452-9015
Mailing Address - Street 1:3211 COORS BLVD SW
Mailing Address - Street 2:D-3
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-5254
Mailing Address - Country:US
Mailing Address - Phone:505-452-9015
Mailing Address - Fax:
Practice Address - Street 1:3211 COORS BLVD SW
Practice Address - Street 2:D-3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5254
Practice Address - Country:US
Practice Address - Phone:505-452-9015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-319261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center